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3. A Delicious and Nutritious Plate

Marsha McCulloch, MS, RDN — Mon, 30 Dec 2019 14:51:21 +0000

What you eat can mean the difference between feeling energized or depleted. It doesn’t mean you never can have a celebratory piece of chocolate cake or slice of gooey cheese pizza—it’s just not food to eat every day. Your body isn’t going to run optimally on meals loaded with high-fat and high-sugar and neither is your brain. A recent study found that people who ate ultra-processed foods gained more weight compared to those who ate minimally processed, even when they consumed the same calories (see “Heavily Processed Foods Lead to Overeating and Weight Gain”). Nourish yourself with fresh whole foods, such as deeply colored veggies and fruits, lean meat, fish, and whole grains, and you’ll create a leaner body and better state of mind.

If you currently have poor eating habits, don’t worry. Small changes can make a difference to your health now and as you get older. Building a highly nutritious diet starts with a positive attitude and appropriate choices in supermarkets, in restaurants, and at home. Many people have successfully overhauled their diets and their lives. You can, too. Start by stocking your pantry with healthy choices and minimizing or eliminating over-processed junk food. The same is true for your refrigerator. Fill it with healthy foods, and reduce temptation by removing fatty, salty, and sugary foods that you know aren’t going to nourish you. You might be surprised how quickly you’ll start to want the right foods and those you used to crave will no longer be so desirable.

Research shows that the human body runs best if 45 to 65 percent of calories come from carbohydrates, 10 to 35 percent come from protein, and the remaining 20 to 35 percent come from fat. There are different ways to achieve these numbers, and lots of healthy, delicious foods from which to choose. It’s a flexible approach with plenty of room for personal preferences.

Your Healthy Eating Style

What you eat and drink daily is what nutritionists call your dietary pattern. The recommendation is tofocus on what you can eat. Instead of thinking about what you can’t eat, consider instead what will nourish you the most. Nutritious foods give you strength, physical energy, and mental clarity. A healthy eating style is not about excluding foods or food groups, demanding you count grams or calories, or relying on supplements. Healthy dietary patterns ensure you get everything you need so you function optimally.

The best diet is a proportion-appropriate eating plan that provides all the nutrients you need to live well, fight disease, be active, and maintain a healthy weight. The current recommendations and tools can make it easier for you to move toward your ideal eating pattern.

From the Department of Health

Every five years, the U.S. Department of Health and Human Services and the U.S. Department of Agriculture (USDA) jointly publish a report with nutritional and dietary information and guidelines. This report, called 2015–2020 Dietary Guidelines for Americans, is required by law to be based on the latest scientific and medical knowledge. While previous editions focused primarily on individual dietary components, such as food groups and nutrients, the 2015–2020 Dietary Guidelines for Americans focuses on eating patterns. This change is in response to the emerging understanding that the components of foods interact with each other and can have cumulative effects on health. It also recognizes that people eat foods, not nutrients (see sidebar, “Dietary Guidelines for Americans”).

Portioning with MyPlate

To make it easier to figure out if you are eating the right foods in the right proportions for optimal health, the USDA in 2011 replaced the longstanding food pyramid with MyPlate, a visual guideline that serves as a reminder of what constitutes a healthy dietary pattern. MyPlate shows half of a nine-inch plate covered with fruits and vegetables, with less than a quarter reserved for protein and slightly more than a quarter for grains.

Choose Color

Fruits and vegetables make up one-half of the MyPlate plate. It is recommended that women and men over 19 years old aim for 1½ to 2 cups of fruit a day and 2½ to 3 cups of vegetables a day, respectively (see “What Counts as a Cup of Fruits and Vegetables?” in Chapter 6).

Fruits and vegetables are generally low in fat, sodium, and calories, and provide many essential nutrients that tend to be lacking in the American diet, including blood-pressure-lowering potassium, cholesterol-lowering fiber, wound-healing vitamin C, and vitamin A, which keeps eyes and skin healthy and helps protect against infections. They also contain a wealth of compounds called phytochemicals that have antioxidant and other powerful health-promoting functions in the body. Eating an overall healthy diet rich in fruits and vegetables may reduce risk for heart disease, obesity, type 2 diabetes, high blood pressure, kidney stones, bone loss, and certain types of cancer. A study published in the International Journal of Preventive Medicine in 2017 found that diets high in phytochemical carotenoids (found primarily in yellow, orange, and red produce) may reduce stroke risk and other cardiovascular events.

A colorful plate is beautiful, delicious, keeps meals interesting, and ensures you get a variety of phytochemicals and other nutrients. Buy fresh produce in season for the best flavor and lowest price, but stock up on frozen, which are often even more nutritious than fresh and certainly more economical. But enjoying these delicious plants of the earth doesn’t just provide you with better health now; eating a variety of produce may pay off in years to come (see “Eat Fruits, Vegetables Now for Cognitive Benefits Later”).

Canned produce can be a good choice as well, but watch out for added sodium. Cans labeled “reduced sodium,” “low sodium,” or “no salt added” are a better choice, even if you add a little salt at home.

Fruit is easy to add to breakfast, throw in a bag for a snack or lunch side, or toss into salads, but it’s also delicious paired with meat dishes, such as chicken with apricots or pineapple on kabobs. Baked apples, poached pears, and fruit salad also make a satisfyingly sweet dessert.

Focus on Lean Protein Foods

The Protein Foods Group includes all foods made from meat, poultry, seafood, beans, peas, eggs, processed soy products, nuts, and seeds. Protein makes up about one-quarter of the MyPlate plate, and it is recommended that men and women over 19 years old consume 5½- to 6½-ounce equivalents of protein a day.

Protein provides the building blocks for bone, muscle, cartilage, skin, and blood, as well as enzymes, hormones, and vitamins. Plant and animal protein sources supply energy-producing B vitamins, antioxidant vitamin E, oxygen-carrying iron, zinc for your immune system, and magnesium to help build strong bones and release energy from muscles. Despite protein’s role as a building block for muscle, a 2018 study from the Institute of Medicine, which included 92 men ages 65 and older, found that simply eating extra protein above the current recommended daily allowance (RDA) does not reverse the muscle loss that comes with aging.

Smart Protein Choices. The type of protein you choose matters for your overall health. Along with your protein, you may be getting high levels of heart-harming saturated fat (from foods like red meat, poultry skin, and full-fat dairy) and sodium (from cured meats like ham); or cancer-causing nitrates from processed meats (sausage, bacon, beef jerky). Likewise, you could get beneficial omega-3 fatty acids (from fish), or fiber and antioxidants (from legumes).

Diets that are high in saturated fats, from foods like red meat and full-fat dairy, raise LDL (“bad”) cholesterol levels in the blood, increasing risk for coronary heart disease. Choose low-fat dairy products and lean or low-fat meat and remove the skin from poultry to cut down on saturated fat intake. Lean cuts of beef include round steaks and roasts, top loin, top sirloin, and chuck shoulder and arm roasts. Choose ground beef that is at least 92 percent lean. Pork loin, tenderloin, center loin, and ham are the leanest cuts of pork. Avoid processed meats, such as sausage, hot dogs, and deli meats. These are often high in saturated fat and sodium and have been associated with increased risk for cancer.

Aim for 8 ounces of seafood a week to help prevent heart disease. All seafood is good, but salmon, trout, sardines, anchovies, herring, Pacific oysters, and Atlantic and Pacific mackerel are particularly high in heart-healthy omega-3 fatty acids. While there has been some concern about mercury levels in fish, the health benefits from consuming seafood outweigh any health risk from mercury.

Beans and peas are classified as part of both the Vegetable Group and the Protein Foods Group. These mature legumes (such as chickpeas, kidney beans, pinto beans, black beans, black-eyed peas, split peas, and lentils) are excellent sources of fiber and nutrients such as potassium and folate, but are also excellent sources of plant protein, and provide iron and zinc, two nutrients found in meats, poultry, and fish. Although they make great vegetarian alternatives for meat, legumes are an excellent addition to any diet. (Green peas, green lima beans, and green string beans are not good protein sources and are not included in this group.) Toss beans on salads, into soups, stews, and chili; use hummus or other bean purée as a sandwich spread or dip; or spice them up and serve over grain.

Vary your protein sources to get the most from this part of your meal. Seafood, beans, and soy products are a great break from meats (beef, veal, lamb, pork, and chicken). Enjoy them as a main dish or side dish frequently. Eating nuts and seeds as part of a balanced dietary pattern is associated with a reduced risk of heart disease, but choose unsalted varieties to keep sodium intake down, and eat them in small portions to avoid excess calories.

People tend to eat most of their protein at the evening meal, with little protein at breakfast. Research suggests that consuming protein at breakfast, lunch, and dinner may better support your ability to maintain muscle mass as you age.

The Goodness of Whole Grains

According to MyPlate, grains or grain-based foods should make up about a quarter of your meal. All adults 19 years old and over should consume 6- to 8-ounce equivalents of grains a day, of which three to four are whole grains.

Whole grains have fiber, several B vitamins, and minerals like iron, magnesium, and immune-boosting selenium. Like fruits and vegetables, whole grains have powerful phytochemicals. Consuming whole grains may reduce the risk of heart disease, ease constipation, reduce inflammation, and aid weight management.

When grains are refined—to turn whole wheat into white flour, or brown rice into white rice, for example—most of these nutrients (and their health benefits) are stripped away. Americans eat a lot of products made from refined wheat flour (white bread, pasta, sweet baked goods), far exceeding recommended amounts of refined grains and falling short on recommendations for eating whole grains.

In 2017, scientists with the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University studied the effects of whole grains and found that eating them helped with weight loss. Women who ate a minimum of 3 ounces daily and men who consumed 4 ounces lost about 100 calories more per day compared to study participants who didn’t eat any grains.

Try to eat whole grains at least three times a day. If this seems like a lot, start by switching out one refined-grain food for a whole-grain version. For example, start the day with oatmeal or whole-grain cereal instead of refined choices at breakfast, use whole-grain bread at lunch, and serve whole grains as a side dish at dinner.

Eating brown rice in place of white rice is one option, but consider trying other grains, too. Barley is a delicious choice and can be used in place of rice as a side dish and in many recipes, like soups, pilafs, and grain-based salads.

Quinoa is quick and easy to cook and versatile, and it’s one of the rare plant sources of protein that contains all the essential amino acids. At snack time, swap in popcorn in place of pretzels or try whole-grain crackers instead of refined.

And, while popcorn is a whole-grain food, sugar-coated or buttery popcorn isn’t the optimal whole-grain choice!

Dietary Patterns

MyPlate is a simple guide to a balanced, varied, and portion-controlled dietary pattern, but there are other ways to approach healthy eating. The Mediterranean eating pattern, the DASH diet (Dietary Approaches to Stop Hypertension), and plant-based diets have all been extensively studied and found to provide major health benefits.

Mediterranean-Style Diet

This diet refers to the traditional eating pattern of people in countries that surround the Mediterranean Sea (e.g., Italy, Greece, Turkey, Israel, and Morocco). In general, a Mediterranean diet focuses on vegetables, fruits, whole grains, legumes, seafood, herbs, spices, nuts, and healthy fats, while minimizing red meat and sweets. Wine (up to one 5-ounce glass per day for women and two glasses for men) can be enjoyed with meals, if desired.

The potential anti-inflammatory effects of the Mediterranean-style dietary pattern are thought to be responsible for its health benefits. This way of eating has been associated with the prevention of cardiovascular disease, type 2 diabetes, atrial fibrillation, and breast cancer. Following a Mediterranean dietary pattern can lower cholesterol and triglyceride levels; protect against oxidative stress, inflammation, and blood clotting; modify hormones and growth factors involved in cancer; and support the health of gut microbiota that influence our metabolic health. The Mediterranean diet also has been linked to a decreased risk of macular degeneration, dementia, and metabolic syndrome, which is a cluster of health problems that includes high blood pressure, elevated blood sugar, abnormal blood cholesterol and triglycerides, and excess abdominal fat that when three or more or together, increase your risk for heart disease and type 2 diabetes.

The DASH Plan

One in every three American adults has high blood pressure (hypertension), and an additional one in three has prehypertension. If you’re one of them, you may want to consider a hypertension diet in line with the Dietary Approaches to Stop Hypertension (DASH) pattern—a pattern recognized to lower blood pressure. However, the DASH dietary pattern is not just for people with high blood pressure; it is an overall healthy choice for anyone.

As with other healthy dietary patterns, DASH recommendations include eating plenty of fruits, vegetables, and whole grains; adding nuts, seeds, and legumes several times a week; keeping dairy products low-fat or fat-free and meats lean; and limiting fats, oils, sweets, and added sugars. DASH emphasizes limiting sodium to under 2,300 milligrams (mg) per day, in addition to focusing on eating plenty of foods rich in nutrients that help to lower blood pressure, including potassium, magnesium, and calcium.

Researchers have reported that the DASH diet may help lower stroke risk by reducing plaque buildup in the arteries. Additionally, DASH may slow the progression of both heart and kidney disease.

Plant-Based Diets

Research clearly associates a diet high in plant foods (like fruits, vegetables, whole grains, and beans) and low in meats with better health. The Meatless Monday campaign, in association with the Johns Hopkins’ Bloomberg School of Public Health (meatlessmonday.com), reports that going meatless even one day a week will not only reduce cancer and heart-disease risk, fight diabetes, curb obesity, and increase life span, it will also support the environment by reducing carbon footprints and water usage and by decreasing dependence on fossil fuels.

Whether you’re a vegetarian (avoiding meat, but still eating eggs and dairy), a vegan (eschewing all animal products), or a pescatarian (including fish and seafood in an otherwise vegetarian or vegan diet), it’s entirely possible to fuel your body for good health, with plenty of energy for exercise left over.

The Value of Variety

All the foods on your plate are a combination of nutrients: macronutrients (protein, carbohydrates, and fats) that provide calories for energy; micronutrients (vitamins and minerals) necessary for body functions; fiber for digestive health and to support a healthy gut microbiome; and powerful antioxidant and anti-inflammatory phytochemicals. A balanced dietary pattern ensures you get the nutrients and food components you need to stay healthy. Micronutrients are essential to everyone, but especially to those with chronic conditions, such as heart failure patients (see “Micronutrients Play Vital Role in Heart Failure Outcomes”).

Understanding Carbs

It is recommended that we get 45 to 65 percent of our calories from carbohydrates (carbs). Carbs are sugars or chains of sugars that serve as the primary fuel for the human body. We get carbs from health-promoting whole grains, fruits, vegetables, legumes, and dairy, but also from refined grain products, sweets, and sugary drinks that typically fall short on the vitamins, minerals, fiber, and phytochemicals found naturally in whole foods.

Whole-food carbs not only provide more of what your body needs for good health, they also tend to be gentler on blood-sugar levels than refined-carbohydrate and sugary foods. Once glucose is in your bloodstream, your pancreas releases insulin to help move the glucose into cells. Because whole foods are generally higher in fiber and move through your digestive tract more slowly, glucose from these foods is absorbed into your bloodstream more slowly and steadily. As a result, your body doesn’t have to release as much insulin to take care of the glucose, so your blood sugar is stable, and you feel better. Avoiding big spikes in insulin followed by large drops in blood sugar can help keep your appetite in check, too.

When it comes to carbs, quality is key, not quantity. Instead of limiting carbs, choose whole food “good carbs” like whole grains, beans, fruits, and vegetables over refined grains and sweets.

Know Your Fats

Approximately 25 to 35 percent of your daily calories should come from fats. Since fats have nine calories per gram (as opposed to protein and carbs, which have four), it doesn’t take a lot of fat to meet this recommendation. Dietary fats are necessary for the absorption of fat-soluble vitamins A, D, E, and K from foods. Fats also give foods a pleasant feel and carry flavor across our tongues, which is why low-fat ice cream just doesn’t feel or taste the same as full fat ice cream. While the calorie density of fats can lead to weight gain, eating some dietary fat is beneficial, and some kinds of fat are essential, since the body can’t make them on its own.

There are different kinds of fats, but they can all be classified as either saturated or unsaturated. Saturated fats (found in animal products and tropical oils like palm and coconut) have been linked to an increased risk of cardiovascular disease, and all major medical organizations recommend limiting saturated fat intake to 10 percent or less of daily calories, which is about 22 grams of fat daily for a 2,000-calorie diet (see “Saturated Fat Recommendations,” on page 30, for more information). Americans currently get more than this recommended amount of saturated fat.

When unsaturated fats (whether mono- or polyunsaturated) replace saturated fats in the diet, the risk of cardiovascular disease goes down. Monounsaturated fats (found in most vegetable oils, nuts, seeds, and avocados) seem to raise HDL (“good”) cholesterol and lower LDL (“bad”) cholesterol and triglyceride levels in the blood. Polyunsaturated fats (in plant oils, fish, nuts, seeds, and soybeans) also can help reduce LDL cholesterol. This class of fats contains the two fatty acids your body can’t make on its own: the essential fatty acids omega-3 and omega-6.

Eating patterns high in omega-3 fats have been shown to reduce inflammation and promote healing after exercise and may increase synthesis of new muscle.

Although fatty fish—like salmon, mackerel, herring, and trout—are by far the top source of the most potent omega-3 fats, you’ll get smaller amounts of omega-3 fats in grass-fed beef (typically sold at farmer’s markets or health-food stores), walnuts, ground flaxseed, and chia seeds. Omega-6s, common in plant oils, are ubiquitous in the Western diet, since they are used often in processed foods.

Man-made trans-fat is by far the most harmful kind of fat. It not only increases cardiovascular disease risk but also promotes inflammation. Foods rich in saturated fat, such as red meat and cheese, also may promote inflammation and chronic disease risk.

Since they are higher in calories than other macronutrients, all fats contribute more readily to unwanted weight gain (including inflammatory abdominal fat), regardless of whether they are classified as “good fat” or “bad fat” from a health perspective.

Phytochemical Power

Special compounds in plants help protect them from disease and repair damage. When you eat plants (fruit, vegetables, whole grains, legumes, nuts, and seeds), those same compounds help protect your cells from disease and repair damage as well. Free radicals, which are compounds that have inflammatory cell- and tissue-damaging effects, form in your body from normal everyday body processes, such as metabolism. The metabolic activity of intense exercise also generates free radicals, but this is largely offset by the fact that exercise up-regulates the body’s natural defenses against them as well. Eating plant foods helps fight these pro-aging compounds.

Plants contain compounds called phytochemicals (plant chemicals) that have powerful impacts on the human body. Antioxidants are phytochemicals that neutralize free radicals, helping to keep cells healthy and reduce systemic inflammation and the risk of diseases, like cancer and cardiovascular disease. Plant-based foods are good sources of a variety of antioxidants.

Although tens of thousands of phytochemicals in foods have been identified, scientists suspect many more exist. Some examples you may be familiar with are lycopene in tomatoes and watermelon (which reduce prostate cancer risk) and lutein in spinach and kiwi (to help prevent age-related blindness). Because we don’t know all of the many health-promoting phytochemicals in foods, consuming whole foods may be better than trying to increase your intake of a single specific nutrient with a dietary supplement.

Additionally, food components act in concert to produce beneficial effects, so isolating individual components into supplements could produce unsatisfactory or unexpected results.

The good news is that you don’t have to be perfect all the time to reap benefits from good nutrition, and a dietary pattern can (and should) be tailored to your personal tastes, preferences, schedule, budget, and current health needs. It needs to fit you to work.

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Keto Diet: The Fat-Burning Health Benefits of Ketogenic Diet Foods

Jami Cooley, RN, CNWC — Wed, 19 Dec 2018 05:00:28 +0000

Originally developed in 1924 to treat epilepsy, the ketogenic diet has most recently rose in popularity as the latest and greatest miracle weight-loss plan. Additionally, proponents of the ketogenic diet—or keto diet, as it’s commonly known—advertise health benefits ranging from glucose control to treatment of Alzheimer’s. But, what does the research really show?

First things first—what is the keto diet?

The ketogenic diet is a high-fat, very-low-carb diet plan. The goal of the diet is to reach a “ketosis” state. The more restrictive you are on your carbohydrates (less than 15g per day), the faster you will enter ketosis. Once in this state, rapid weight loss begins. Research does indicate that the ketogenic diet is most effective in weight loss by reducing visceral (body) fat.

Keto Diet Basics

Your keto diet plan will include lots of high-protein meats, vegetables, avocados, nuts and seeds, and dairy—but very little in the way of carbs. [Photo: © Azurita | Dreamstime]

The nutrient intake during a keto diet should be around 70 percent fats, 25 percent protein, and 5 percent carbohydrates. Recommended foods to eat on this meal plan include:

Meats (chicken, fish, beef, and lamb, for example)
Above-ground vegetables (but avoid root vegetables)
Leafy greens
High-fat dairy (cheese, cream, and butter, for example)
Nuts and seeds
Avocados
Berries (but avoid other fruits)
Healthy fat and oils (olive oil, coconut oil, and fish oil, for example)

How Does the Keto Diet Work?

Within the mitochondria of every cell, either glucose (carbohydrates) or fatty acids are metabolized to form the energy molecules, ATP (Adenosine Triphosphate). The object of a ketogenic diet is to force the body into a glycogen-deprived state, referred to as ketosis.

Since the body does not have enough glucose needed for energy, the metabolic process of ketosis ensues: The body begins to mimic a “starvation” state, where it burns stored fats for energy. This leads to the build-up of ketones within the body.

The results? Ketones are able to generate greater amounts of energy per molecule than glucose. Therefore, the ketones create a much more sustainable energy source for the body and do not cause the blood sugar spikes that glucose causes.

4 Additional Health Benefits of Ketogenic Diet

Aside from the weight-loss potential, the keto diet, according to research, offers the following health benefits.

Suppresses the hunger hormone, ghrelin. Typical diet patterns lead to increased hunger and reduced feelings of fullness due to an increase in the hormone, ghrelin. The ketogenic diet does not increase ghrelin levels, which means the body can “mimic” a starvation state, but you don’t actually feel hungry.
Controls glucose and reduces diabetic symptoms. In a randomized study of overweight adults with type 2 diabetes, the participants were divided into two groups. The first group followed a 32-week ketogenic diet program while the second group followed the conventional low-fat, diabetes diet plan. At the end of the study, the ketogenic diet group improved their glycemic control and lost more weight than the other group. The research showed that the ketogenic diet improved the participants’ blood glucose levels while also reducing the need for insulin.
Improves memory and reduces midlife mortality. In a study published in the journal Cell Metabolism, researchers fed mice an isoprotein ketogenic diet every other week. The results showed decreased obesity, reduced midlife mortality, and prevention of memory decline. (See also “Ketogenic Diet Shows Promising Results for All Dementia Stages.”)
Reduces mitochondrial free radial production, which decreases oxidative stress. Research demonstrates that the ketogenic diet reduces free radical levels in the brain. Furthermore, studies in cardiac tissue have suggested that ketones reduce oxidative stress, a pathogenic process implicated in many disorders ranging from atherosclerosis (plaque in the arteries) to other diseases more specific to the nervous system.

Is the Ketogenic Diet Safe for Everyone?

Even though the ketogenic diet has been shown to improve many chronic illnesses, the diet is contraindicated in people who are taking certain medications—blood pressure medications, for example, or antidepressant drugs.

Also, people who take diabetic medications such as insulin should strictly monitor for sudden drops in blood sugar levels while following the keto diet.

Additionally, people with gallbladder disease, pancreatic insufficiency, a history of kidney stones, or a history of anorexia should talk with their doctor regarding the safety of a ketogenic diet program. Last, women who are pregnant or breastfeeding require higher protein intake and should adjust the ketogenic diet plan to meet this macronutrient need.

All of this being said, don’t let these cautionary statements stop you from beginning a research-proven weight-loss program involving the ketogenic diet. Being overweight or obese can be far more damaging to your health, so talk to your doctor about beginning the keto diet program today.

The keto diet Food Pyramid tells the story of the low-carb, high-fats/proteins ketogenic diet. [Photo: © Irina Miroshnichenko | Dreamstime]

[1] Avoli, M. (2012). Herbert H. Jasper and the Basic Mechanisms of the Epilepsies. Jaspers Basic Mechanisms of the Epilepsies, 12-23. doi:10.1093/med/9780199746545.003.0002.
[2] Wolver, S., Konjeti, V. R., Carbone, S., Abbate, A., & Puri, P. (2017). Successful Weight Loss with Low Carbohydrate Ketogenic Diet (LCKD) Significantly Reduced Visceral Fat and Increased Fat Free Mass in Obese. Gastroenterology,152(5). doi:10.1016/s0016-5085(17)32870-6.
[3] Sai Krishna G et al. Ketogenic Diet in the Management of Diabetes. Indo American Journal of Pharmaceutical Research.2017:7(06).
[4] J Med Internet Res. 2017 Feb; 19(2): e36.
[5] Newman, J. C., Covarrubias, A. J., Zhao, M., Yu, X., Gut, P., Ng, C., . . . Verdin, E. (2017). Ketogenic Diet Reduces Midlife Mortality and Improves Memory in Aging Mice. Cell Metabolism, 26(3). doi:10.1016/j.cmet.2017.08.004.
[6] Neuroscience. 2007 Mar 2; 145(1): 256–264.

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Complete Nutrition: Vegetables Are Essential

Dawn Bialy — Mon, 10 Dec 2018 05:00:38 +0000

Vegetables have always had a reputation for boosting our health. Research continues to support the long-held standard that a vegetable-rich diet is a key part of any complete nutrition plan—and a winning approach to optimal health and disease protection.

Research suggests that a vegetable-rich diet can lower your risk of certain types of cancer, cardiovascular disease, type 2 diabetes, cognitive decline, age-related eye diseases, osteoporosis, lung diseases, and chronic inflammation. That’s why the USDA MyPlate guide, which has taken over the traditional role of the food pyramid, suggests that adults include two to three cups of vegetables each day in their healthy meal plans for complete nutrition.

In addition, many vegetables are considered fat-burning foods, since your body expends more calories to break down and digest them than they contain. If you are trying to lose weight or prevent weight gain, foods in the vegetable family can help you achieve your goal.

Complete Nutrition: Think “Rainbow”

When it comes to veggies, the more variety, the better. By choosing from the rainbow-hued spectrum of vegetables, you will get a wide array of nutrients and phytochemicals, plant nutrients that have antioxidant and anti-inflammatory actions.

If you’re eating the same five or six vegetables week in and week out, you may not be getting the complete nutrition you need. Expand your dietary horizons and put a few new varieties on your healthy grocery list each week.

Although all vegetables are superfoods, here we provide more nutritional information on some that rank among the cream of the crop when it comes to a complete nutrition diet.

Vegetable Medley: Six to Keep in Your Diet

Asparagus. Asparagus spears are packed with nutrition; they provide the most folic acid per serving in the vegetable world along with potassium, fiber, protein, other B vitamins, and minerals such as copper, selenium, manganese, zinc, and iron.

Asparagus also contains powerful phytochemical compounds: rutin, which helps strengthen capillary walls; the “master” antioxidant, glutathione, which supports immune system function and aids in removing toxins from your body; the fiber inulin, which is known for colon health; and saponins, which have been linked to blood glucose and cholesterol control.

Avocado. Avocados contain healthy, unsaturated fats linked with heart protection, along with fiber, vitamins, minerals, and phytochemicals. While a calorie-counter may bypass avocados, research has shown that including avocados in your diet can in-crease satiety (fullness) and provide weight control benefits. One ounce of avocado contains only 50 calories but provides a multitude of health-protective nutrients, including vitamins K, C, and E, folate, phytosterols, and many phytochemicals.

Broccoli. Broccoli provides high levels of vitamins A, C, and K, folic acid, and fiber, as well as some protein and omega-3 fatty acids. In addition, broccoli and other cruciferous vegetables contain phytochemicals called glucosinolates, which have cancer-fighting potential. Hundreds of studies have found that broccoli may reduce chronic inflammation and oxidative stress, which may help ward off cancer.

Carrots. Carrots are very high in vitamin A (113 percent of the recommended daily value), as well as biotin, vitamins B6, C, and K, fiber, and potassium. In addition, they have many phytochemicals, such as carotenoids (including alpha-carotene, beta-carotene, and lutein) and anthocyanidins. Studies have linked carrot consumption to cardiovascular health, vision health, and cancer protection.

Green, leafy vegetables. Green, leafy vegetables are nutritional superstars; they provide at least 19 essential nutrients, including magnesium, potassium, iron, folate, and vitamins C and K. In addition, many contain calcium that is needed for bone health. And, they are packed with potent phytochemicals, such as beta-carotene, chlorophyll, lutein, and zeaxanthin, which possess antioxidant and anti-inflammatory properties. Green, leafy vegetables have been linked to protection against age-related eye disease, cancer, osteoporosis, and even mental decline. Including green, leafy vegetables in your diet several times a week will help you get the complete nutrition your body needs. (See also Benefits of Cruciferous Vegetables: Eat Your Brassicas!)

Tomatoes. Tomatoes contain a variety of nutrients, including vitamins A, B6, C, and K, biotin, copper, potassium, manganese, and fiber. In addition, tomatoes are the richest source of the phytochemical lycopene, which paints its flesh bright red. Lycopene has attracted the attention of nutrition researchers for its powerful antioxidant and anti-inflammatory actions. In particular, tomatoes seem promising in the protection against prostate cancer and possibly breast cancer, as well as heart disease, UV-related skin damage, and osteoporosis.

A Word on Starchy Vegetables

Some vegetables are higher in carbohydrates and starch than others. Starchy vegetables include potatoes, winter squash (acorn squash, butternut squash, spaghetti squash, Hubbard squash, and others), corn, peas, and most types of beans. These foods are good sources of important vitamins and minerals, just like vegetables that contain fewer carbs. However, higher carbs means a higher calorie count. This does not mean you need to avoid these vegetables, but it’s wise to limit the amount you eat.

Here’s a good nutrition tip: When it comes to meal planning, put starchy vegetables in the same category as rice, pasta, and bread, and have only one food from this category per meal. For example, have potatoes and asparagus rather than potatoes and corn, or acorn squash and a salad, rather than acorn squash and pasta. Pairing starchy vegetables with vegetables lower in starch will help you increase your overall intake of vegetables while reducing the chance of overloading on higher-calorie choices.

Here are carbohydrate (in grams) and calorie counts of some high-starch and low-starch vegetables (per one cup cooked, unless otherwise noted):

Pinto beans: 45 grams (g), 245 calories
Black beans: 41 g, 220 calories
Lima beans: 39 g, 216 calories
Black-eyed peas (cowpeas): 35 g, 198 calories
Russet potato: 42 g, 194 calories
Sweet potato: 42 g, 180 calories
Yellow corn: 31 g, 134 calories
Acorn squash: 30 g, 115 calories
Green peas: 25 g, 134 calories
Carrots: 12 g, 54 calories
Broccoli: 11 g, 54 calories
Brussels sprouts: 11 g, 56 calories
Tomatoes: 10 g, 43 calories
Green snap beans: 10 g, 34 calories
Spinach: 7 g, 41 calories
Asparagus: 7 g, 40 calories
Zucchini: 5 g, 27 calories
Lettuce (2 cups raw): 3 g, 16–20 calories

By including both starchy and non-starchy vegetables in your diet plans, you’ll get a wide range of nutrients that have been linked with many health benefits.

Originally published in 2016 and updated.

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3. Shape Up your Plate

Cindy Foley — Mon, 26 Nov 2018 19:23:54 +0000

No matter what your current eating habits are, and no matter what health issues you may have, even small steps that move you toward a more nutritious diet can have a positive impact on your health now and in the years to come.

Decades of research have determined that the human body runs best if 45 to 65 percent of calories come from carbohydrates, 10 to 35 percent come from protein, and the remaining 20 to 35 percent come from fat. The easy way to make sure your intake is lining up with recommendations is to follow a dietary pattern.

Ideal Dietary Patterns

The food and drink choices you make day in and day out comprise your dietary pattern. Rather than excluding foods or food groups, demanding you count grams or calories, or relying on supplements, dietary patterns ensure you get everything you need so your body functions at its best.

The ideal diet is one that provides all of the nutrients and compounds you need to live, fight disease, and be active, in the proportions you need to maintain a healthy weight. The latest recommendations and tools can make it easier for you to make the behavior changes necessary to move toward an ideal eating pattern.

Dietary Guidelines for Americans

Every five years, the U.S. Department of Health and Human Services and the U.S. Department of Agriculture (USDA) jointly publish a report with nutritional and dietary information and guidelines. This report, called “Dietary Guidelines for Americans,” is required by law to be based on the latest scientific and medical knowledge. While previous editions focused primarily on individual dietary components, such as food groups and nutrients, the 2015–2020 Dietary Guidelines for Americans focuses on eating patterns. This change is in response to the emerging understanding that the components of foods interact with each other and can have cumulative effects on health. It also recognizes that people eat foods, not nutrients.

According to the guidelines, a healthy eating pattern includes:

A variety of vegetables from all of the subgroups: dark green, red and orange, legumes (beans, peas, lentils, and peanuts), starchy, and other
Fruits, especially whole fruits
Grains, at least half of which are whole grains
Fat-free or low-fat dairy, including milk, yogurt, cheese, and/or fortified soy beverages
A variety of protein foods, including seafood, lean meats and poultry, eggs, legumes, and nuts, seeds, and soy products
Oils

A healthy eating pattern limits:

Saturated fats (should be limited to less than 10 percent of calories per day)
Trans fats (should be as close to zero as possible)
Added sugars (should make up less than 10 percent of calories per day) see sidebar, “Recommended Intake of Added Sugars”

Sodium (less than 2,300 milligrams per day)
If alcohol is consumed it should be consumed in moderation—up to one drink per day for women and up to two drinks per day for men of legal drinking age (see Chapter 4, “Fluids,” for more information).

MyPlate

MyPlate shows half of a nine-inch plate covered with fruits and vegetables, with less than a quarter reserved for protein and slightly more than a quarter for grains.

Fruits and Vegetables

Fresh, canned, frozen, dried, or juiced … fruits and vegetables provide nutrients vital for your health. Fruits and vegetables make up one-half of the MyPlate plate. It is recommended that women and men over 19 years old aim for 1½ to two cups of fruit a day, and 2½ to three cups of vegetables a day (see “What Counts as a Cup of Fruits and Vegetables?” in Chapter 6).

Varying your fruits and veggies not only keeps meals interesting; it insures you get a variety of phytochemicals and other nutrients. Buy fresh produce in season for the best flavor and lowest price, but stock up on frozen, which are often even more nutritious than fresh and certainly more economical.

Upping your veggie intake is not difficult. Main-dish salads make easy and versatile meals. Toss extra veggies into soups, stews, stir-fries, and casseroles. Top pizza with extra veggies (and have a side salad in place of an extra slice). If you’re not a big vegetable fan, try dips and sauces (but watch the fat and salt), and experiment with different cooking techniques and seasonings to get these colorful, health-boosting goodies back on your plate.

Protein Foods

Protein provides the building blocks for bone, muscle, cartilage, skin, and blood, as well as enzymes, hormones, and vitamins. Plant and animal protein sources supply energy-producing B vitamins, antioxidant vitamin E, oxygen-carrying iron, zinc for your immune system, and magnesium to help build strong bones and release energy from muscles. Despite protein’s role as a building-block for muscle, new research found that simply eating extra protein above the current RDA does not reverse the muscle loss that comes with aging.

Make Smart Protein Choices

The type of protein you choose matters for your overall health. Along with your protein, you may be getting high levels of heart-harming saturated fat (from foods like red meat, poultry skin, and full-fat dairy) and sodium (from cured meats like ham); or cancer-causing nitrates from processed meats (sausage, bacon, beef jerky). Likewise, you could get beneficial omega-3 fatty acids (from fish), or fiber and antioxidants (from legumes).

Diets that are high in saturated fats, from foods like red meat and full-fat dairy, raise LDL (“bad”) cholesterol levels in the blood, increasing risk for coronary heart disease. Choose low-fat dairy products and lean or low-fat meat and remove the skin from poultry to cut down on saturated fat intake. Lean cuts of beef include round steaks and roasts, top loin, top sirloin, and chuck shoulder and arm roasts. Choose ground beef that is at least 92 percent lean. Pork loin, tenderloin, center loin, and ham are the leanest cuts of pork. Avoid processed meats, such as ham, sausage, hot dogs, and deli meats. These are often high in saturated fat and sodium and have been associated with increased risk for cancer.

Aim for eight ounces of seafood a week to help prevent heart disease. All seafood is good, but salmon, trout, sardines, anchovies, herring, Pacific oysters, and Atlantic and Pacific mackerel are particularly high in heart-healthy omega-3 fatty acids. While there has been some concern about mercury levels in fish, the health benefits from consuming seafood outweigh any health risk from mercury.

Beans and peas are classified as part of both the Vegetable Group and the Protein Foods Group. These mature legumes (such as chickpeas, kidney beans, pinto beans, black beans, black-eyed peas, split peas, and lentils) are excellent sources of fiber and nutrients such as potassium and folate but are also excellent sources of plant protein and provide iron and zinc like meats, poultry, and fish. Although they make great vegetarian alternatives for meat, legumes are an excellent addition to any diet. (Green peas, green lima beans and green string beans are not good protein sources and are not included in this group.) Toss beans on salads, into soups, stews, and chili; use hummus or other bean puree as a sandwich spread or dip; or spice them up and serve over grain.

Vary your protein sources to get the most from this part of your meal. Seafood, beans, and soy products are a great break from meats (beef, veal, lamb, pork, and chicken). Enjoy them as a main dish or side dish frequently. Eating nuts and seeds as part of a balanced dietary pattern is associated with reduced risk of heart disease, but choose unsalted varieties to keep sodium intake down, and eat them in small portions to avoid excess calories.

Grains

Grains are the seeds of grasses. According to MyPlate, grains or grain-based foods should make up about one quarter of your meal. It is recommended that men and women 19 years old and over consume six- to eight-ounce equivalents of grains a day, of which at least three to four are whole grains.

When grains are refined—to turn whole wheat into refined white flour, or brown rice into white rice, for example—most of these nutrients (and their health benefits) are stripped away. Americans eat a lot of products made from refined wheat flour (white bread, pasta, sweet baked goods), far exceeding recommended amounts of refined grains and falling short on recommendations for eating whole grains.

Try to eat whole grains at least three times a day. If this seems like a lot, start by switching out one refined grain food for a whole-grain version. One study found every whole-grain serving (16 grams) resulted in a 9 percent lower risk of cardiovascular disease-related deaths, a 5 percent lower risk of cancer-related deaths, and a 7 percent lower risk of dying overall.

It’s not difficult to add whole grains to your plate. Start the day with oatmeal or whole-grain cereal instead of refined choices at breakfast, use whole-grain bread at lunch, and serve whole grains as a side dish at dinner. Eating brown rice in place of white rice is one option, but consider trying other grains, too. Barley is a delicious choice and can be used in place of rice as a side dish and in many recipes, like soups, pilafs, and grain-based salads. Quinoa is quick and easy to cook and versatile, and it’s one of the rare plant sources of protein that contains all the essential amino acids. At snack time, swap in popcorn in place of pretzels or try whole-grain crackers instead of refined.

If you’re eating processed foods, keep in mind that whole-grain options can still be high in added sugars and/or saturated fat. For example, whole-grain muffins, although better than their refined-grain counterparts, may contain a lot of sugar and/or saturated fat and should be eaten in moderation. And, while popcorn is a whole-grain food, sugar-coated or buttery popcorn isn’t the optimal whole-grain choice! See ChooseMyPlate.gov for a wealth of information and tips for making your plate MyPlate.

Other Dietary Patterns

Mediterranean-Style Eating Patterns

A Mediterranean-style diet refers to the traditional eating pattern of people in countries that surround the Mediterranean Sea. In general, a Mediterranean diet focuses on vegetables, fruits, whole grains, legumes, seafood, herbs, spices, nuts, and healthy fats, while minimizing red meat and sweets. Wine (up to one five-ounce glass per day for women and two glasses for men) can be enjoyed with meals, if desired.

Olive trees are common in the Mediterranean, and olive oil—particularly extra virgin olive oil (EVOO)—is a key part of Mediterranean eating. The monounsaturated fats in olive oil have beneficial health effects, as do the high levels of antioxidant phytochemicals. Recent research on rats found that physical activity combined with an EVOO-enriched diet was helpful for osteoarthritis.

The potential anti-inflammatory effects of the Mediterranean-style dietary pattern are thought to be responsible for its health benefits. This way of eating has been associated with the prevention of cardiovascular disease, type 2 diabetes, atrial fibrillation, and breast cancer. Following a Mediterranean dietary pattern can lower cholesterol and triglyceride levels; protect against oxidative stress, inflammation, and blood clotting; modify hormones and growth factors involved in cancer; and support the health of gut microbiota that influence our metabolic health. The Mediterranean diet also has been linked to decreased risk of macular degeneration, dementia, and metabolic syndrome, which is a cluster of health problems that include high blood pressure, elevated blood sugar, abnormal blood cholesterol and triglycerides, and excess abdominal fat.

Dietary Approaches to Stop Hypertension

In 2016, researchers found the DASH diet may help to lower stroke risk by reducing plaque buildup in the arteries. Additionally, DASH may help protect against other medical conditions, including osteoporosis, kidney stones, diabetes, and some cancers, and can slow the progression of both heart and kidney diseases.

Plant-Based Diets

Research clearly associates a diet high in plant foods (like fruits, vegetables, whole grains, and beans) and low in meats with better health. The Meatless Monday campaign, in association with the Johns Hopkins’ Bloomberg School of Public Health (meatlessmonday.com), reports that going meatless even one day a week will not only reduce cancer and heart-disease risk, fight diabetes, curb obesity, and increase life span, it will also support the environment by reducing carbon footprint and water usage and by decreasing dependence on fossil fuels.

Whether you’re a vegetarian (avoiding meat, but still eating eggs and dairy), a vegan (eschewing all animal products), or a pescetarian (including fish and seafood in an otherwise vegetarian or vegan diet), it’s entirely possible to fuel your body for good health, with plenty of energy for exercise left over.

A Word on Specific Nutrients

All the foods on your plate are a combination of nutrients: macronutrients (protein, carbohydrates, and fats) that provide calories for energy; micronutrients (vitamins and minerals) necessary for every body function; fiber for digestive health and to support a healthy gut microbiome; and powerful antioxidant and anti-inflammatory phytochemicals. A balanced dietary pattern ensures you get all of the nutrients and food components you need to stay healthy.

Good Carbs/Bad Carbs

Whole-food carbs not only provide more of what your body needs to or good health, they also tend to be gentler on blood-sugar levels than refined-carbohydrate and sugary foods. Once glucose is in your blood stream, your pancreas releases insulin to help move the glucose into cells. Because whole foods are generally higher in fiber and move through your digestive tract more slowly, glucose from these foods is absorbed into your bloodstream more slowly and steadily. As a result, your body doesn’t have to release as much insulin to take care of the glucose, so your blood sugar is stable and you feel better. Avoiding big spikes in insulin followed by large drops in blood sugar can help keep your appetite in check, too.

The Glycemic Index (GI) groups carbs by how quickly and how much they raise blood sugar. GI is a popular method for deciding which carbs are “good” and which are “bad.” Unfortunately, recent research found that GI charts may not be reliable.

When it comes to carbs, quality is key, not quantity. Instead of limiting carbs, choose whole-food “good carbs” like whole grains, beans, fruits, and vegetables over refined grains and sweets.

Good Fats/Bad Fats

It’s recommended that 25 to 35 percent of your daily calories come from fats. Since fats have nine calories per gram (as opposed to protein and carbs, which have four), it doesn’t take a lot of fat to meet this recommendation. Dietary fats are necessary for the absorption of fat-soluble vitamins A, D, E, and K from foods. Fats also give foods a pleasant mouth-feel and carry flavor across our tongues, which is why low-fat ice cream just doesn’t feel or taste the same as full-fat. While the calorie density of fats can lead to weight gain, eating some dietary fat is beneficial, and some kinds of fat are essential, since the body can’t make them on its own.

There are different kinds of fats, but they can all be classified as either saturated or unsaturated. Saturated fats (found in animal products and tropical oils like palm and coconut) have been linked to an increased risk of cardiovascular disease, and all major medical organizations recommend limiting saturated fat intake to 10 percent or less of daily calories, which is about 22 grams of fat daily for a 2000-calorie diet (see “Saturated Fat Recommendations” for more information). Americans currently get more than this recommended amount of saturated fat.

When unsaturated fats (whether mono- or polyunsaturated) replace saturated fats in the diet, risk of cardiovascular disease goes down. Monounsaturated fats (found in most vegetable oils, nuts, seeds, and avocados) seem to raise HDL (“good”) cholesterol and lower LDL (“bad”) cholesterol and triglyceride levels in the blood. Polyunsaturated fats (in plant oils, fish, nuts, seeds, and soybeans) can also help reduce LDL cholesterol. This class of fats contains the two fatty acids our body can’t make on its own: the essential fatty acids omega-3 and omega-6.

Eating patterns high in omega-3 fats have been shown to reduce inflammation and promote healing after exercise and may increase synthesis of new muscle.

Man-made trans fat is by far the most harmful kind of fat. It not only increases cardiovascular disease risk but also promotes inflammation. Foods rich in saturated fat, such as red meat and cheese, also may promote inflammation and chronic disease risk.

Fabulous Phytochemicals

Special compounds in plants help protect them from disease and repair damage. When you eat plants (fruit, vegetables, whole grains, legumes, nuts, and seeds) those same compounds help protect your cells from disease and repair damage as well. Free radicals, which are compounds that have inflammatory cell- and tissue-damaging effects, form in your body from normal everyday body processes, such as metabolism. The metabolic activity of intense exercise also generates free radicals, but this is largely offset by the fact that exercise up-regulates the body’s natural defenses against them as well. Eating plant foods helps fight these pro-aging compounds.

Plants contain compounds called phytochemicals (plant chemicals) that have powerful impacts on the human body. Antioxidants are phytochemicals that neutralize free radicals, helping to keep cells healthy and reduce systemic inflammation and the risk of diseases, like cancer and cardiovascular disease. Vitamins C and E, while not phytochemicals, have antioxidant effects as well. Plant-based foods are good sources of a variety of antioxidants.

Although tens of thousands of phytochemicals in foods have been identified, scientists suspect many more exist. Some examples you may be familiar with are lycopene in tomatoes and watermelon (which reduce prostate cancer risk) and lutein in spinach and kiwi (to help prevent age-related blindness). Because we don’t know all of the many health-promoting phytochemicals in foods, consuming whole foods may be a better than trying to increase your intake of a single specific nutrient with a dietary supplement. Additionally, food components act in concert to produce beneficial effects, so isolating individual components into supplements could produce unsatisfactory or unexpected results.

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Healthy Desserts? Keep Your Focus on Nutritious Fruits

Dawn Bialy — Mon, 30 Apr 2018 05:00:35 +0000

Fruits provide slow-digesting carbs, various types of fiber, and a host of vitamins, including A, C, E, and K plus several B vitamins. Fruits also provide many important minerals, including calcium, potassium, manganese, magnesium, and copper, along with a cornucopia of phytochemicals. Among plant foods, fruits are especially high in phytochemicals that reduce inflammation and oxidative stress. For all of the reasons above, it makes sense to use fruits to create healthy desserts that are low in calories and fat and high in flavor.

Plus, fruits won’t contribute to weight gain the way that foods with added sugars can—a typical serving of fruit provides about 60 calories. So if you’re trying to lose weight or prevent weight gain, foods in the fruit family can help you achieve your goal.

Benefits of Fruit in Your Diet

Research links fruit consumption to numerous health benefits, such as lowering the risk of:

Apples and bananas are the perfect go-to snack for people with diabetes.

The USDA MyPlate guide, which has taken over from the food pyramid as the preferred guide to making complete nutrition choices, suggests that adults consume 1 to 2 cups of fruit per day as part of a healthy meal plans.

It’s important to note that every fruit is a superfood. Include a variety of fruits—fresh, canned, frozen, or dried, with no added sugar—in your diet plan every week.

Fruits to Keep in Your Diet

Here’s a selection of fruits that have garnered the most documented health benefits in scientific studies and that can serve as (or combine to serve as) healthy desserts.

- Apples. Apples are rich in vitamin C, and they also are high in the soluble fiber pectin, which has been shown to lower blood cholesterol and protect against heart dis-ease. Apples contain a phytochemical called quercetin, which has been linked to slowing down the digestion of carbohydrates, thus improving blood glucose control. Eat the skin to gain the most fiber and phytochemical content. An increasing body of research links apples to health benefits, such as weight control, digestive and immune health, cancer prevention, and cardiovascular health.

- Bananas. Each banana furnishes a generous supply of vitamins B6 and C, manganese, fiber, potassium, biotin, and copper. In addition, bananas contain plant sterols linked with heart health, and special types of fibers that foster the growth of friendly bacteria in the gut. It’s easy to turn bananas into a delicious, healthy dessert; just bake the bananas in their skins, add a drizzle of honey and sprinkle with chopped nuts. Or, toss a banana and some berries into the blender with low-fat yogurt and ice, and you’ve got a delicious, healthy snack.

RECIPE TREAT

(Photo courtesy of TOPS.org)

Here’s an easy-to-make recipe suggestion: a Mini Strawberry Parfait. It’ll take just five minutes to whip up this low-calorie treat from TOPS.org. Click here for ingredients and directions.

- Berries. Berries are high in fiber, potassium, and vitamin C as well as phytochemicals. Berries are tops in terms of antioxidant content because of their rich cache of phytochemicals. Multiple studies have identified that berries may have a profound impact on health, lowering the risks of cancer, cardiovascular disease, diabetes, and age-related mental decline. Enjoy berries as a snack, in salads and smoothies, or as a healthy dessert.

- Stone fruit. Stone fruit—peaches, nectarines, plums, apricots, cherries—are all members of the Prunus genus, which share a similar characteristic: a very large and hard seed, or “stone.” The nutritional profile of stone fruit varies depending on the type and variety of fruit, though they are all generally rich in soluble fiber, slow-digesting carbohydrates, vitamin C, potassium, and phytochemical.Stone fruits have been linked with preventing diabetes, metabolic syndrome, and cardiovascular disease. Those with beta-carotene (a precursor to vitamin A), such as peaches, nectarines, and apricots, are also linked to eye protection. Anthocyanins in cherries have been found to ease arthritis symptoms and muscle pain after exercise, as well as improve parameters of heart health.

- Citrus. Citrus fruits have been recognized for their health benefits for centuries. They are famously rich in the powerful antioxidant vitamin C, but they also provide potassium, folate, calcium, thiamin, niacin, vitamin B6, phosphorus, magnesium, copper, riboflavin, pantothenic acid, and fiber. Benefits linked with eating citrus fruits include protection against heart disease, stroke, arthritis, asthma, cognitive decline, age-related eye diseases, and diabetes.

Citrus fruits protect against heart disease, diabetes, arthritis, and other afflictions.

Originally published in 2016, this post is regularly updated.

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Even If You’re Healthy, You Can Still Have a Heart Attack: Symptoms of Heart Disease You Can’t Ignore

Elaine Fawcett — Wed, 27 Dec 2017 13:20:16 +0000

Do you live a healthy lifestyle by following a whole grain diet? Unfortunately, despite your actions to thwart a heart attack, your whole grain diet may do more harm than good. Why? Because the root cause of heart disease is inflammation! And, managing inflammation goes much beyond the standard prevention advice of eating whole grains.

Preventing a Heart Attack: Symptoms of Heart Disease Linked with a Whole Grain Diet

Opting for whole wheat bread may seem like a healthy choice; however, research suggests otherwise. Consider that the carbohydrate-laden food pyramid was introduced approximately 30 years ago. Since that time, the number of people with heart disease and other chronic illnesses has drastically increased. Death from cardiovascular disease alone exceeds 1 million annually in the United States.[1] The truth is that certain types of grains exacerbate inflammation in the body, causing disease. Particularly, refined grains (cereals, breads, pastas, etc.) are largely devoid of fiber, minerals and vitamins. Furthermore, as many as one in five people have a gluten sensitivity.[2] So for the gluten-intolerant person, even whole wheat products can cause inflammation and therefore increase the risk of heart disease. In fact, more and more people are discovering that they can significantly reduce inflammation by eliminating grainsall together.

How Does Inflammation Increase the Risk of Heart Disease?

Inflammation creates lesions on arterial walls, thus contributing to the formation of plaque within the arteries—a process known as “atherosclerosis.” In order to quickly repair the lesions, the body “patches” them up with cholesterol. Although an effective short-term fix, this eventually leads to the creation of artery-clogging plaque, and drives up the risk of heart disease and sudden heart attack.

What are the heart disease and heart attack symptoms?

A person with heart disease (coronary artery disease) will typically have the following symptoms, especially if they are following a grain-heavy diet:

High LDL cholesterol levels/high triglycerides
Heart palpitations, fluttering or racing heartbeat
Fatigue
High blood pressure with or without episodes of dizziness or lightheadedness

In addition to the symptoms of coronary artery disease, it is important to be aware of heart attack symptoms. A heart attack can occur suddenly, even in a person who does not have a history of heart disease or high cholesterol problems. Therefore, you should call 911 or seek medical help right away if you experience any of these 5 common heart attack symptoms:

Chest pain
Arm or shoulder pain
Shortness of breath
Pain in the jaw, neck or back
Feeling weak, dizzy, faint or light-headed

Eating Whole Grains Can Also Cause Fluctuations in Blood Sugar

Aside from increasing the risk of high cholesterol and/or heart disease, grain-based diet may also be too high in carbohydrates for some, causing blood sugar to swing dramatically between extreme highs and lows. This leads to a drop in energy, sugar and/or caffeine cravings, sleep issues, and most importantly, inflammation. High-carbohydrate diets—even those high in fibrous whole grains—can prove too inflammatory for some people. Thus, anti-inflammatory foods such as leafy, colorful vegetables and mildly sweet fruits (i.e. berries) are a better choice.

Gut Health and Heart Disease

Other causes of inflammation include: an overgrowth of harmful bacteria in the gut, poor function of the digestive organs, and gastric irritation. All of these factors play a role in increasing the risk of heart disease. In fact, studies suggest that the overgrowth of one strain of gastric bacteria in particular—“H. pylori”—increases the risk of heart disease.[3] Caused by insufficient acidity in the stomach, the usually symptomless H. pylori is responsible for peptic ulcers—a condition estimated to affect many Americans.

The Source of Inflammation is Different for Everyone

You can see why reducing inflammation is “at the heart” of reducing your risk of heart attack, symptoms of heart disease, and ultimately, saving your life. You can also see why statin drugs do not address the root cause of high cholesterol for most people – while they may decrease your high cholesterol numbers, the inflammation and risk of heart attack still rages on.

The source of inflammation can vary for each individual, but typically it involves evaluating one’s diet, immune health, and digestive function. In order to successfully reduce your risk of heart attack, you have to fix the source of inflammation. Following an anti-inflammatory, ketogenic diet and balancing the bacteria balance in the gut with probiotic supplements is a good place to start.

[1] J Am Coll Nutr June 2000 vol. 19 no. suppl 3 291S-299S.

[2] Eur Rev Med Pharmacol Sci. 2010 Jun;14(6):567-72.

[3] Recenti Prog Med. 2009 Feb;100(2):91-6.

This post originally appeared in 2012 and has been updated.

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1. Eating Wisely As You Age

UHN — Tue, 07 Mar 2017 18:21:50 +0000

How Diet Makes a Difference

We all know that eating a healthy diet is important for growing children, and the obesity epidemic and soaring rates of diabetes, cardiovascular disease, and other chronic diseases dramatically demonstrate the need to eat right from young adulthood into middle age. But does what you eat really matter as you grow older? Isn’t there a point in life where you can eat whatever you want?

If that’s what you think, you might want to consider a saying often attributed to pitcher Satchel Paige: “If I knew I was going to live this long, I would have taken better care of myself.” The evidence is overwhelming that the dietary choices you make as you age can improve your quality of life, as well as extend its length.

In 2013, the Centers for Disease Control and Prevention published the 10 leading causes of death for different age groups. Five of the leading causes of death for individuals over age 60 are conditions that benefit from diet and nutrition intervention: cardiovascular disease, cerebrovascular disease, type 2 diabetes, cancer, and kidney disease. Besides shortening your life, all of these conditions also affect how much you can enjoy your life.

Cardiovascular Disease

This condition that affects the heart and blood vessels is the leading cause of death in the US and around the world. Three risk factors for cardiovascular disease that are influenced by diet are unhealthy blood lipid levels (including high LDL cholesterol and triglycerides), high blood pressure (hypertension), and, of course, obesity.

Helen M. Rasmussen, PhD, RD, senior research dietitian at Tufts’ USDA Human Nutrition Research Center on Aging (HNRCA) and co-creator of MyPlate for Older Adults (a dietary plan discussed later in this chapter), points out: “Weight reduction and subsequent maintenance of normal weight for those who are overweight or obese can increase one’s enjoyment of everyday activities. Imagine carrying around a 20-pound sack of flour with you wherever you go. Once you have eliminated the baggage of extra pounds, you may feel lighter, breathe easier, and be able to get around more comfortably with less joint pain. It may even encourage you to increase your activity routine, hence improving your mobility and revving up your metabolism.”

As a bonus, she says, weight reduction can also help you get a good night’s rest, since being overweight is associated with a higher incidence of sleep apnea.

Diet and Your Brain

Cerebrovascular diseases are conditions that develop as a result of problems with the blood vessels that supply the brain. The most common types of cerebrovascular diseases are the different types of stroke. Problems with blood circulation that result in inadequate blood flow to the brain can also cause vascular dementia. The most important risk factor for cerebrovascular diseases is high blood pressure. Says Dr. Rasmussen, “Lowering dietary sodium levels has been shown to decrease blood pressure. People over the age of 50 should aim to keep their sodium intake at 1,500 milligrams per day. Although the optimal level of sodium intake is currently under debate, it is a fact that most Americans consume too much sodium, and cutting back on sodium is definitely a healthy choice.”

A healthy diet has also been shown to reduce your risk of Alzheimer’s disease and other forms of dementia. Both the Mediterranean-style diet and the DASH eating plan, which are discussed later in this chapter, have been associated with cognitive benefits. A hybrid of these plans that emphasizes brain-protective foods, the “MIND” diet, may be even more effective (see Box 1-1, “New Dietary Approach Against Alzheimer’s”).

Diabetes Risk

Type 2 diabetes, a condition identified by high blood glucose (sugar) levels in the bloodstream, is associated with a two to four times higher risk of death from heart disease or stroke. Other complications from diabetes include vision loss, kidney disease, and neuropathy (nerve damage, usually in the legs and feet). Maintaining a normal weight and choosing foods that do not rapidly raise blood glucose can help you control your blood glucose levels. Eating less saturated fat, avoiding high-sugar food items, and eating more fruits, vegetables, and whole grains are also recommended to help control the complications of diabetes, as well as preventing or delaying its onset.

Food and Cancer

The relationship between diet and cancer risk is less well understood, but experts advise maintaining a healthy weight, limiting red meats, and processed meats, and eating more fruits and vegetables and whole grains to reduce your risk. According to the American Cancer Society, it has been estimated that as many as one-third of all cancer deaths in the US are related to diet and activity factors.

Chronic Kidney Disease

This condition, abbreviated CKD, means your kidneys cannot properly filter waste from your blood; these waste products remain in your body and can cause health problems. The chances of developing CKD increase with age; it most commonly affects individuals age 70 and over. Those who have diabetes, hypertension, cardiovascular disease, and are obese are at risk for CKD, so a healthy diet and keeping yourself well-hydrated can reduce your risk.

Your Changing Nutrient Needs

People’s nutritional needs change with age. As activity levels decrease and muscle mass declines, older people need to consume fewer calories; some may also simply have a reduced appetite, and illness or medications can affect the appeal of food. If you’re consuming fewer calories, however, it’s more important to get the most nutritional “bang” for your caloric “buck.”

The Importance of Nutrient Density

Choosing foods high in key vitamins, minerals, fiber, protein, and other essentials means emphasizing nutrient density, rather than energy density. What’s the difference? A medium apple and an eight-ounce glass of non-diet cola both contain about 100 calories, but the apple contains fiber, vitamin C, potassium, and other nutrients—it’s more nutrient dense. The cola is energy dense—high in calories—because of its high sugar content, but it provides no healthy nutrients.

Nutrient-dense foods include fruits and vegetables, whole grains, seafood, lean poultry and meats, dairy products, and eggs. Most popular snacks such as potato chips or corn chips, sugary beverages, and baked goods made from refined grains are less nutrient-dense. In general, nutrient-dense choices are more likely to be whole foods rather than processed or refined, contain little or no added sugar or fat, and have less saturated fat for the amount of nutrients than similar products.

If you’re eating less as you get older—whether because your appetite declines or you’re avoiding obesity—make sure you’re choosing nutrient-dense foods. Eat a banana instead of a candy bar, broccoli rather than French fries, yogurt rather than a bag of chips, and whole-wheat bread instead of a white dinner roll.

Are You Getting Enough?

Another reason to make smart food choices as you get older is that you might not be getting enough of certain key nutrients. This can occur either because your body and lifestyle have changed or because your needs have increased with age. Examples include:

Vitamin B12. The amount of B12 your body needs for proper blood-cell formation, neurological function, DNA synthesis, and other tasks doesn’t change with age, but your ability to obtain this vitamin from food might. Although B12 is a water-soluble vitamin, B12 that is naturally present in foods such as meat, fish, poultry, eggs, and dairy products is bound to proteins in the food. In your stomach, hydrochloric acid and pepsin (an enzyme that breaks down proteins) release the B12 for your body to use. But people with low levels of stomach acid, whether due to aging or the use of certain medications, can’t extract as much dietary B12. And, a condition called atrophic gastritis, which decreases the secretion of hydrochloric acid in the stomach, affects between 10 percent and 30 percent of older adults.

The vitamin B12 found in fortified foods, such as breakfast cereals, is different. The crystalline synthetic form of B12 added to foods or used in supplements is already in a free form that doesn’t require stomach acid for your body to use it. The Institute of Medicine recommends that people over age 50 obtain most of their vitamin B12 from fortified foods and supplements.

Vitamin D. Essential for bone health and a wide range of metabolic processes, vitamin D can be difficult to obtain in adequate amounts from food alone. With age, your body also loses some of its natural ability to make vitamin D in your skin from sun exposure, and older people often spend less time out in the sun.
Calcium. The amount of calcium needed to maintain bone density and prevent fractures increases for women over age 50 and for all adults over age 70. Because there are some possible side effects from high levels of calcium in supplement form, experts advise getting as much of your daily calcium needs as possible from dietary sources (see Box 1-2, “Food Sources of Calcium”).

Iron. Once women hit menopause, their iron needs decrease to the same amount as men, but, for both genders, low stomach acid canaffect the ability to absorb iron from foods.
Fiber. When you get older, none of the organs and organ systems in your bodies function as efficiently as they used to, including the GI tract. This means constipation is more likely; getting enough dietary fiber can help. Adequate fiber intake has also been linked to lower risks of several diseases associated with aging, including cardiovascular disease, diabetes, and colorectal cancer.
Water. Thirst, rather than some “rule” about drinking eight glasses of water a day, is your best guide to staying hydrated. However, your sense of thirst diminishes with age, so you may need to pay closer attention to getting enough water and other healthy fluids to prevent dehydration. Water is also important when consuming fiber because it helps fiber bulk up and keep wastes moving through your intestines.

Medications and Nutrients

The medications that so many of us take as we get older can also contribute to nutrient shortfalls. In 2007 through 2010, almost 50 percent of all Americans reported taking one or more prescription drugs in the past 30 days; use increased with age, with the number climbing to 90 percent among those age 65 and over. Medications can interfere with your body’s ability to utilize nutrients by impairing digestion and the availability or storage of nutrients, as well as by increasing losses of nutrients by excretion. Among the most common medications that affect nutrition are:

Antacids/Proton-pump inhibitors (PPIs): Taken for heartburn and indigestion, these drugs can negatively affect the absorption of vitamin B12, folic acid, vitamin C, calcium, magnesium, iron, and zinc.
Metformin: This common diabetes medication has been shown to contribute to depletion of vitamin B12 and possibly folic acid.
Anti-hypertensives: Medications for high blood pressure can decrease the availability and increase the elimination of zinc. They also increase the excretion of B vitamins, vitamin C, potassium, magnesium, and calcium.
Statins: These widely prescribed cholesterol medications can increase the depletion of coenzyme Q10 and have been associated with vitamin D insufficiency.
Bronchodilators: Used for asthma and other breathing difficulties, these increase the excretion of vitamin B6 and calcium and block vitamin D absorption.

Other Reasons for Shortfalls

There may be other reasons you’re not getting enough of the right nutrients as you age. These can include health conditions such as heartburn or reflux, poor dentition, difficulty swallowing, or nausea or loss of appetite from chemotherapy or other medical treatments. Or, you might simply be less able to or less interested in cooking or going to the grocery store, as often occurs due to factors such as reduced mobility, lack of transportation, depression, or adjusting to the loss of a spouse.

You might not even be aware that such factors are causing you to miss out on healthy eating. Friends and relatives, especially those who live far away and see you only at intervals, may be the first to notice such warning signs as weight loss or lagging appetite. Make sure to discuss any such issues with your physician, too, and use your regular physical as a check-up on your weight.

A diet with softer, less spicy, and more easily digestible foods can often address this sort of nutrition shortfall. You may want to consult a registered dietitian (RD) for help in adjusting your diet.

Do You Need Supplements?

Nutrition experts agree that the best way to get the nutrients you need at any age is by consuming a healthy diet. When individual vitamins and minerals have been tested in supplement form, the results have mostly been disappointing; this suggests that it’s difficult to replicate the benefits of the nutrient mix of whole foods. Exceptions where the evidence is clear for a benefit from supplements include the AREDS antioxidant formula for lowering the risk of macular degeneration and the fortification of foods with folic acid to reduce birth defects. As noted above, older people may also benefit from supplemental vitamin B12 or foods fortified with the supplemental form. Because it can be difficult to obtain adequate vitamin D from foods, especially in northern latitudes or with limited sun exposure, experts often suggest supplements.

What about multivitamins, which are used by about 40 percent of US adults? Multivitamin and mineral supplements can fill in the gaps and enhance the intake of problem nutrients for many Americans. Studies have shown that users of such supplements have higher blood levels of vitamins A, C, D, and E and several B vitamins, as well as lower levels of homocysteine, an important marker of cardiovascular disease. The evidence on whether taking a multivitamin actually decreases your risk of heart disease or cancer is mixed.

When choosing any type of supplement, exercise caution: Testing has revealed that some supplements contain more or less of the active ingredient(s) listed on the label and/or potentially harmful substances. Look for the “USP Verified Mark” on the label—this means the supplement has been tested by the US Pharmacopeia (see Box 1-3, “USP Verified Mark”). A USP seal ensures that the product is made in accordance with Good Manufacturing Practices, contains the ingredients listed on the package, and does not contain harmful levels of contaminants.

Supplements and “Shakes” Cautions

If you do choose to take supplements, check with your doctor first, and make sure he or she knows what you are taking. Supplements can interact with many medications. Too much supplemental calcium, particularly taken all at once rather than spread throughout the day, may increase the risk of kidney stones. If you have been diagnosed with precancerous colon polyps, limit folic acid to 400 micrograms daily, as more may contribute to cancer formation. (Since you’re also getting folic acid in fortified foods, you may want to take a multivitamin only every other day.) Beta-carotene and vitamin E beyond the amount in typical multivitamins should also be avoided.

How about drinking your nutrition in the form of a shake? The American Geriatrics Society recently advised against using the popular liquid supplements even for most older adults suffering unintentional weight loss. “There is no evidence that they affect other important clinical outcomes, such as quality of life, mood, functional status, or survival,” according to the society’s latest Choosing Wisely guidance for physicians and patients. At the society’s annual scientific meeting, Paul Mulhausen, MD, who led the Choosing Wisely work group, pointed out that such beverages’ primary ingredients are water and several forms of sugar, calling the products “liquid candy bars with vitamins.”

Make MyPlate Your Plate

When the federal government retired its longstanding food pyramid, replacing the familiar icon with a new dietary-guidance symbol, MyPlate, Tufts nutrition scientists created a corresponding MyPlate for Older Adults. The new graphic, updated in 2016, calls attention to the unique nutritional and physical activity needs associated with advancing years. Alice H. Lichtenstein, DSc, director of Tufts’ HNRCA Cardiovascular Nutrition Laboratory, collaborated with HNRCA senior research dietitian Helen M. Rasmussen, PhD, RD, to develop it (see Box 1-4, “MyPlate for Older Adults,” on page 15).

MyPlate for Older Adults spotlights different forms of vegetables, fruits, and other healthy food choices that are convenient, affordable, and readily available. Unique components include icons for regular physical activity and emphasis on adequate fluid intake, both of particular concern for older adults. The graphic illustrates:

Brightly-colored vegetables such as carrots and broccoli
Deeply-colored fruits such as berries and peaches
Whole, enriched, and fortified grains and cereals such as brown rice and 100% whole wheat bread
Low- and non-fat dairy products such as yogurt and milk
Protein sources such as beans and peas, nuts, fish, poultry, lean meat, and eggs
Liquid vegetable oils, soft spreads low in saturated and trans fat, and herbs and spices to replace salt
Fluids such as water, tea, coffee, and fat-free milk.

Each of these food and beverage groupings will be explored in depth, with spotlights on smart choices within each group and ways to include more in your diet, in subsequent chapters of this book, beginning with chapter 3.

Foods to Focus On

“Half of the MyPlate for Older Adults graphic includes fruit and vegetable icons, which reflects the importance of eating several servings of fruits and vegetables per day in a range of colors,” says Dr. Rasmussen. “Consuming a variety of produce with deeply-colored flesh, such as peaches, berries, tomatoes, kale, and sweet potatoes, introduces a larger amount of plant-based nutrients and fiber into your diet.”

Dr. Lichtenstein adds, “We also include icons representing frozen, pre-peeled fresh, dried, low-sodium, and low-sugar canned options because fruits and vegetables in these forms contain as many or more nutrients as fresh—and they are easier to prepare, are more affordable, and have a longer shelf life.”

Such factors are important to consider, she notes, when arthritis kicks in or dark, cold days mean it is less likely someone will go out to replenish the refrigerator.

MyPlate for Older Adults provides examples of whole, enriched, and fortified grains because they are high in fiber. Suggested protein sources include plant-based options, such as beans and tofu, as well as fish, poultry, and lean meat. Drs. Lichtenstein and Rasmussen recommend vegetable oils and soft spreads rich in unsaturated fats as alternatives to foods high in animal fats such as butter that are higher in saturated and trans fat.

Special Cases

Some elements of the MyPlate for Older Adults graphic factor in the special needs of older adults. “Blood pressure tends to increase as we age, so it is especially important for older adults to monitor dietary salt and, for most of us, try to find ways to decrease intake,” says Dr. Lichtenstein. “MyPlate for Older Adults suggests alternatives to salt, such as flavoring with spices, and choosing the low-sodium options of items such as canned vegetables.”

The inclusion of several examples of liquids such as water, tea, coffee, and soup addresses the common, age-related decline in thirst that can put older adults at risk for dehydration.

Also intentionally represented on the MyPlate for Older Adults are a fork and knife that serve as reminders to put down remote controls and smart phones and occupy both hands with eating utensils. Dr. Lichtenstein says, “The focus should be on the enjoyment of foods and beverages, on the amount consumed, and, whenever possible, on the opportunity for social interaction at mealtimes.”

MyPlate for Older Adults also promotes regular physical activity with icons depicting common activities that include daily errands and household chores. Although some of those chores do not take the place of more formalized exercise routines involving cardiovascular activities, those included serve to remind older adults of the variety of options for regular physical activity.

Eating Like a Mediterranean

This book largely follows the advice of MyPlate for Older Adults because this plan uniquely addresses the nutritional needs associated with aging. However, you may have also heard of other eating plans for which research has shown health benefits. For example, the so-called “Mediterranean” diet, which has been linked to reduced risks of heart disease and cognitive decline, often in appears in headlines about health and diet. We say “so-called” because there is no “official” Mediterranean diet; in fact, the Mediterranean-style dietary plans tested in research vary widely. Moreover, even in the countries bordering the Mediterranean Sea, traditional healthy ways of eating are increasingly giving way to more American-style fare, driven by convenience and economics.

A healthy Mediterranean-style diet includes many of the same key ingredients found in MyPlate for Older Adults. The chief difference between a Mediterranean-style diet and other healthy-eating plans (such as DASH, described next in this chapter) is the emphasis on unsaturated fats found in plant foods, especially monounsaturated fat in the form of olive oil. All healthy diets recommend limiting foods high in saturated fat, such as fatty meats and full-fat dairy, minimizing added sugar, and avoiding processed foods.

What “Mediterranean” Really Means

To follow a healthy diet based on Mediterranean foods, you need to know that many modern-day foods we associate with Mediterranean countries—pizza or spaghetti from Italy, moussaka or spanikopita from Greece—don’t fit in the healthy dietary plans promoted as “Mediterranean.” Take pasta as an example: Although you may think it is “Mediterranean food,” the refined grains used in familiar pasta dishes have had most of their original nutrients stripped away. Instead, healthy Mediterranean eating plans emphasize whole grains, much like the Dietary Guidelines for Americans.

The heaping helpings of cheese we associate with pasta dishes and pizza are out, too. Cheese is high in saturated fat, one of the primary elements that is minimized in a healthy diet. The unofficial but widely adopted “Mediterranean diet pyramid” promoted by the non-profit Oldways group (see Box 1-5, “Mediterranean Diet Pyramid,” on page 18) puts cheese at the top portion of the pyramid, indicating that it should be eaten infrequently and in moderate portions.

Think instead of Mediterranean fare consumed by the poorer peoples of the region. As Oldways explains, “The ‘poor’ diet of the people of the southern Mediterranean, consisting mainly of fruits and vegetables, beans and nuts, healthy grains, fish, olive oil, small amounts of dairy, and red wine, proved to be much more likely [than a ‘modernized’ diet] to lead to lifelong good health.”

For some suggestions on following a healthy Mediterranean-style diet, see Box 1-6, “Mediterranean Diet: 8 Steps to Get Started,” on page 19.

DASH to Good Health

Another healthy regimen, the Dietary Approaches to Stop Hypertension (DASH) plan, was designed by the National Heart, Lung and Blood Institute based on clinical studies that tested the effects of sodium and other nutrients on blood pressure. The first DASH study compared three eating plans: a typical American diet, the typical American diet with added fruits and vegetables, and the DASH plan. All three plans were moderate in sodium. People who followed the high fruits and vegetables plan had reduced blood pressure, and those who followed the DASH eating plan saw their blood pressure drop even more.

A second DASH study examined the effects of restricting sodium on blood pressure. The greatest blood pressure reduction occurred with the DASH plan that was lowest in sodium—just 1,500 milligrams daily.

Starting a DASH Plan

To get a healthy start on DASH-style eating, follow these simple steps:

MORE

Fruits
Vegetables
Whole grains
Nuts and legumes
Low-fat dairy (2-3 daily servings)

LESS

Red and processed meats
Sweetened beverages
Sodium

You can download the complete DASH plan for free at
http://1.usa.gov/1qvoimN.

Even if you don’t have high blood pressure, you can benefit from this healthy way to eat. In a review of six studies that examined the DASH-style diet in relation to heart health, researchers linked this dietary pattern to a 20 percent reduction in cardiovascular disease, a 21 percent reduction of coronary heart disease, a 19 percent reduction in stroke, and a 29 percent reduction in heart failure.

These findings are also powerful evidence of the ability of dietary changes to improve your quality of life and reduce your risk of life-threatening diseases. In the next chapter, we’ll show you how easy it can be to start eating better—and boosting your health—right away.

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Stop Worrying About Total Fat

UHN Staff — Tue, 14 Feb 2017 20:56:01 +0000

Two of the nation’s leading nutrition experts have some advice for the federal government: Stop worrying about total fat. Nutrition research has shown that the emphasis on restricting total fat intake is outdated, yet these limits affect everything from Nutrition Facts labels to school lunches to supermarket products. In recent opinion pieces in JAMA and the New York Times, Dariush Mozaffarian, MD, DrPH, and David S. Ludwig, MD, PhD, argue, “It’s long past time for us to exonerate dietary fat.”

Dr. Mozaffarian is dean of Tufts’ Friedman School of Nutrition Science and Policy and editor-in-chief of the Tufts Health and Nutrition Letter. Dr. Ludwig is on the staff of Boston Children’s Hospital and directs the New Balance Foundation Obesity Prevention Center.

However the federal government responds to this call for change—in the upcoming 2015 US Dietary Guidelines, revised nutrition labeling and other policies—you can catch up with the latest nutrition science in your own grocery shopping and food preparation right now. If, like Uncle Sam, you’re still worrying about the total fat numbers and calories from fat on the Nutrition Facts panel, it’s time to take a more nuanced view. If you’re avoiding foods high in healthy unsaturated fats, you need to rethink your fear of fats.

DATED NUMBERS: The 2015 report of the Dietary Guidelines Advisory Committee (DGAC) drew headlines for overturning most concerns about consumption of dietary cholesterol, as in eggs (see the May newsletter). Tufts faculty members Alice H. Lichtenstein, DSc, and Miriam Nelson, PhD, served on the committee, and Lichtenstein was vice-chair. As Dr. Mozaffarian and Dr. Ludwig point out, however, “A less noticed, but more important, change was the absence of an upper limit on total fat consumption.”

Noting that reducing total fat intake by substituting carbohydrates does not reduce cardiovascular risk, the DGAC concluded, “Dietary advice should put the emphasis on optimizing types of dietary fat and not reducing total fat.”

CONFUSION REIGNS

Consumers and most of the media haven’t gotten the message about total fat. Just recently, a Sunday newspaper supplement listed five keys to preventing heart disease—among them, “Avoid fats.” A popular healthy-cooking magazine recommended using “peanut butter powder” in a recipe to avoid the (mostly unsaturated) fat in peanut butter. No wonder that a 2014 Gallup poll found a majority of Americans still trying to cut down on their intake of all fats. Dr. Mozaffarian and Dr. Ludwig comment, “This fear of fat also drives industry formulations, with heavy marketing of fat-reduced products of dubious health value.”

That recommendation, if reflected in the final guidelines due later this year, would reverse 35 years of nutrition policy. In 1980, the federal Dietary Guidelines first recommended limiting dietary fat to less than 30% of calories. Since one gram of fat—regardless of the type of fat—contains about 9 calories, in a 2,000-calorie daily diet that advice translated to a maximum of 65 grams of fat per day. The 1980 recommendation was revised in the 2005 guidelines to a range of 20% to 35% of calories from total fat. But the percentages used in the Nutrition Facts panel continue to be based on the 1980 recommendation of 30% or 65 grams.

SUBSTITUTING CARBS: Fat is a concentrated source of calories—that 9 calories per gram of fat compares to 4 per gram of protein or carbohydrate. So limiting fat intake seemed like a sound strategy for preventing obesity. As the Times op-ed recounts, “By the mid-1990s, a flood of low-fat products entered the food supply: nonfat salad dressing, baked potato chips, low-fat sweetened milk and yogurt and low-fat processed turkey and bologna. Take fat-free Snackwell’s cookies. In 1994, only two years after being introduced, Snackwell’s skyrocketed to become America’s No. 1 cookie, displacing Oreos, a favorite for more than 80 years.”

In place of fat, Americans were advised to eat carbohydrates, which were positioned as the foundation of a healthy diet. In 1992, the USDA’s famous “food pyramid” recommended up to 11 daily servings of bread, cereal, rice and pasta. (By contrast, the current MyPlate nutrition icon recommends women consume five to six ounces or ounce-equivalents of grains, depending on their age, and six to eight for men. At least half those servings should be whole grains.)

Replacing fats with carbohydrates, especially refined sources as in packaged foods, backfired as an anti-obesity strategy. Between 1980 and 2000, obesity rates among US adults doubled.

In the thinking behind the 1980 total-fat limit, saturated fat was also linked to unhealthy cholesterol levels. “But the campaign against saturated fat quickly generalized to include all dietary fat,” Dr. Mozaffarian and Dr. Ludwig write in JAMA. “Moreover, a global limit on total fat inevitably lowers intake of unsaturated fats, among which nuts, vegetable oils and fish are particularly helpful.”

NEW FACTS ON FAT

Cnderstanding the latest evidence about total fat intake and health can help you to rethink how you use nutrition labels. Here’s an updated way to look at the Nutrition Facts panel, even as the FDA considers possible revisions, using peanut butter (high in healthy fats) as an example:

Compare the serving size to how much you actually eat. If a “serving” of peanut butter is two tablespoons but you normally spread three, take these numbers times 1.5. (The FDA plans to update serving sizes to make them more realistic.)
Tufts’ Dr. Mozaffarian advises, “Only pay attention to total calories if comparing two similarly unhealthy foods: e.g., two bagels, two candies, two processed meats. When eating minimally processed healthful foods, don’t focus on calories, but eating until you’re satisfied.”
Ignore the number of calories from fat, which the FDA has already proposed deleting from revised labeling.
Don’t worry about the total fat number or percentage. You can, however, subtract the saturated fat number from the total fat to calculate the grams of unsaturated (mono- and poly-) fat. Exact amounts vary by brand, but a typical serving of peanut butter might contain about 9 grams of monounsaturated fat and 4.5 grams of polyunsaturated fat. Foods higher in unsaturated fats, as a proportion of total fat, are generally better options.
Avoid any food listing more than zero grams of trans While some foods labeled as zero might still have trace amounts (less than 0.5 grams) of industrial trans fats, by mid-2018 even these will be gone. (See the September newsletter.)
Most people don’t need to worry about dietary cholesterol intake. If you have diabetes or you’re at higher risk for diabetes, check with your physician.
Avoid products higher in sodium. Compare sodium levels in different products in similar categories (e.g., two breads, two soups, two cheeses) and always move toward lower sodium, with a goal of less than 2,000 milligrams a day.
When choosing grains or other carbohydrate-rich foods, aim for at least 1 gram of fiber for every 10 grams of total carbohydrates (a 1:10 ratio).

“Most important, don’t pick or avoid any food based on a single number on the label,” says Dr. Mozaffarian. “Indeed, foods without labels are probably the best bet, most of the time, in the first place.”

DEFINING “HEALTHY”: The realization that all fats are not equally to be avoided has been slow to penetrate official standards as well as the popular mindset (see box), however. It’s not just the Nutrition Facts panel that’s behind the times: The FDA’s definition of “healthy” as a claim allowed on packaging still includes a requirement that a product be low not just in saturated fat but also in total fat. (See our June Special Supplement for more on these often-confusing label terms.)

Earlier this year, that outdated definition led the agency to formally warn makers of a popular brand of snack bars to stop marketing several of their products as “healthy.” But the fats in those snack bars mostly come from healthy sources such as nuts and vegetable oil and are mostly unsaturated. The FDA’s definition of “healthy,” however, has no similar limits on sugar, refined grains or starch.

Other federal programs must adhere to the dietary guidelines, which still limit total fat. So the National School Lunch Program bans whole milk because of its fat content, but allows skim milk that’s been sweetened with sugar. The National Institutes of Health’s “We Can!” program to promote healthy eating recommends that families and children eat “almost anytime” fat-free salad dressing and ketchup (both sources of sugar). But the program advises eating “sometimes or less often” all vegetables with added fat, nuts, peanut butter, olive oil and tuna canned in oil. Whole milk and “eggs cooked with fat” are relegated to the same category as candy, chips and non-diet soda.

PREFER A HEALTHY PATTERN: “This is not to say that high-fat diets are always healthy, or low-fat diets always harmful,” the experts’ Times op-ed cautions. “But rather than focusing on total fat or other numbers on the back of the package, the emphasis should be on eating more minimally processed fruits, nuts, vegetables, beans, fish, yogurt, vegetable oils and whole grains in place of refined grains, white potatoes, added sugars and processed meats. How much we eat is also determined by what we eat: Cutting calories without improving food quality rarely produces long-term weight loss.”

You don’t need to wait for the release of the 2015 dietary guidelines, which may make changes as suggested by the DGAC. When eyeing the Nutrition Facts panel (see box) or other labeling, you can stop worrying about total fat. Look at the numbers for nutrients you probably need more of, such as dietary fiber, vitamins and minerals other than sodium. For choosing healthier breads, cereals and other carb-rich foods, Dr. Mozaffarian recommends foods with at least 1 gram of fiber for every 10 grams of total carbohydrates, rather than focusing on sugars or fiber alone. (For more on the importance of dietary patterns and food choices—not simply calories—see our August 2015 Special Report.)

But, as Dr. Mozaffarian and Dr. Ludwig emphasize, healthy eating is about more than numbers and labels. That DGAC report, notable for its omission of limits on total fat, is a good place to start in planning your meals and grocery shopping. According to the report, a “healthy dietary pattern is higher in vegetables, fruits, whole grains, low- or nonfat dairy, seafood, legumes and nuts, moderate in alcohol (among adults), lower in red and processed meats, and low in sugar-sweetened foods and drinks and refined grains.”

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2. Brain-Healthy Dietary Patterns

UHN — Wed, 01 Feb 2017 19:15:46 +0000

When the latest Dietary Guidelines for Americans (DGAs) were released in January 2016, they earned headlines for their focus on added sugars and relaxed view of dietary fat. But the most important point of the updated DGAs was often overlooked in the flurry of media coverage: Healthy eating is more than just eating more of this nutrient and less of that one—instead, it’s about adopting a healthy eating pattern.

According to a statement accompanying the DGAs’ release, “The path to improving health through nutrition is to follow a healthy eating pattern that’s right for you. Eating patterns are the combination of foods and drinks you eat over time. A healthy eating pattern is adaptable to a person’s taste preferences, traditions, culture and budget.”

As we’ll see in this chapter, a healthy eating pattern is especially important to protecting your brain.

Basics of a Healthy Pattern

The updated DGAs didn’t recommend a single, one-size-fits-all dietary pattern, although several of the patterns we’ll discuss later in this chapter were cited as healthy examples. The DGAs did, however, offer a list of what to look for in a healthy dietary pattern—good advice for lifelong healthy eating, as well as a smart start for eating right for your brain. These principles include consuming:

A variety of vegetables from all of the subgroups—dark green, red and orange, legumes (beans and peas)
Fruits, especially whole fruits
Grains, at least half of which are whole grains
Fat-free or low-fat dairy, including milk, yogurt, cheese, and/or fortified soy beverages
A variety of protein foods, including seafood, lean meats and poultry, eggs, legumes (beans and peas), and nuts, seeds, and soy products
Unsaturated oils
A healthy eating pattern limits saturated fats and trans fats, added sugars, and sodium

Dividends for Your Brain

In general, the DGAs’ recommendations align with recent research on dietary patterns that are most protective for your brain. For example, one study found that an overall diet high in key nutrients—B vitamins and vitamins C, D, and E—and low in unhealthy fats moderated cognitive decline associated with aging. The study combined tests of mental performance with MRI scans to measure brain health, and used blood tests to analyze dietary patterns. After adjusting for other factors known to be associated with cognitive decline, researchers identified three distinct patterns:

The most consistent “favorable pattern” for mental function included the combination of high blood levels of vitamins B1, B2, B6, folate, B12, C, D, and E. Seniors with higher levels of these vitamins scored better in overall cognitive function, particularly in tests of attention, visual-spatial function, and executive function. If your blood levels of these vitamins are high, it’s a sign that you’re eating lots of vegetables and fruits, as the DGAs recommend.
People with high blood levels of omega-3 fatty acids, predominantly found in fatty fish, scored significantly better on tests of executive function than those with lower levels of omega-3s. Omega-3s were not linked to better scores in a battery of standard cognitive tests, however.
On the other hand, high blood levels of trans fats were linked most strongly with negative performance. We know that trans fats are bad for your heart and, therefore, your brain’s blood vessel functioning. But these unhealthy fats, in the form of partially hydrogenated vegetable oils, are found in bakery products, processed foods, and fast foods, and are also an indicator of an overall unhealthy dietary pattern. The FDA has announced that most partially hydrogenated vegetable oils will be banned in foods by mid-2018.

The results of the MRI scans were consistent with the cognitive testing. There was a direct relationship between blood levels of vitamins B, C, D, and E and brain size. By contrast, there was a negative relationship between trans fat levels and brain size.

Meet the MIND Diet

A study published in the journal Alzheimer’s & Dementia in September 2015 offered intriguing evidence of a dietary pattern that seems especially well suited to protecting the brain. While both a Mediterranean-style diet and the DASH eating plan are associated with brain benefits (as we’ll see later in this chapter), a hybrid dietary pattern that combines the best of both with the latest cognitive research may protect memory and thinking even better.

In the study, this MIND (Mediterranean-DASH Intervention for Neurodegenerative Delay) diet was associated with a slower rate of cognitive decline—equivalent to 7.5 years of younger age. Those with the highest MIND diet scores were 53 percent less likely to develop Alzheimer’s disease than those with the lowest scores.

Similar to the Mediterranean and DASH regimens, MIND “emphasizes natural plant-based foods and limited intakes of animal and high saturated-fat foods, but uniquely specifies the consumption of berries and green leafy vegetables.”

There are some differences, too. The MIND diet doesn’t specify high fruit consumption other than berries. MIND drops the DASH recommendation for high dairy consumption and calls for only weekly fish consumption, which is lower than recommended in the Mediterranean diet.

Diet and Developing Alzheimer’s

The prospective study used a food questionnaire to score 923 participants, ages 58 to 98 years, for adherence to each type of diet: MIND, DASH, or Mediterranean-style. Participants were then followed for an average 4.5 years to track who developed Alzheimer’s disease; during the study, 144 incident cases of Alzheimer’s were diagnosed.

The lower risk for those most closely following the MIND diet was similar to those with the highest adherence to a Mediterranean diet (54 percent) and the DASH plan (39 percent). But only the top one-third of Mediterranean and DASH scores were associated with lower Alzheimer’s risk. The second-highest third of MIND scores were also associated with lower risk (35 percent), however, suggesting that even modest dietary improvements following the MIND pattern could be beneficial.

“Inflammation and oxidative stress play a large role in the development and progression of Alzheimer’s disease,” says Tammy Scott, PhD, a scientist at Tufts’ HNRCA Neuroscience and Aging Laboratory. “The MIND diet particularly emphasizes foods, such as green leafy vegetables, berries, and olive oil, which are rich in antioxidants and anti-inflammatory agents that may help to protect against dementia and cognitive decline.”

Healthy Hybrid

Martha Clare Morris, ScD, of Rush University, and colleagues developed the MIND diet score as a hybrid of the Mediterranean and DASH (Dietary Approaches to Stop Hypertension) diets. But it also particularly focuses on “the dietary components and servings linked to neuroprotection and dementia prevention.” Many of these components are foods and nutrients we’ll look at in depth in the next few chapters.

Scientists compared the three diets using data on 923 participants in the Rush Memory and Aging Project, ages 58 to 98. Participants were initially free of Alzheimer’s disease;

Participants filled out a 144-item food questionnaire. Their responses were then assigned points to score how closely their diets matched each of the three dietary patterns being tested.

Although the observational study was not designed to prove cause and effect, Morris and colleagues noted that the results “suggest that even modest adjustments to the diet may help to reduce one’s risk of Alzheimer’s disease. For example, the MIND diet score specifies just two vegetable servings per day, two berry servings per week, and one fish meal per week.” Those recommendations are much lower and easier to achieve than comparable guidelines in the Mediterranean or DASH plans (see Box 2-1, “What’s Your MIND Score?”)

A Plan for Older Adults

Another way of looking at dietary patterns that might be particularly protective as you age is to consider how the federal Dietary Guidelines for Americans and the accompanying MyPlate graphic (which replaced the familiar “food pyramid” in 2011) might be adapted to the special needs of older adults. In March 2016, nutrition scientists at Tufts’ Jean Mayer USDA Human Nutrition Research Center on Aging (HNRCA) introduced an updated MyPlate for Older Adults (see Box 2-2, “MyPlate for Older Adults,” on page 19). Revised to reflect the latest Dietary Guidelines for Americans, this system calls attention to the unique nutritional and physical activity needs associated with advancing years, emphasizing positive choices.

Calories and Nutrients

One important change as you get older is that your calorie needs typically decrease after age 50; men generally need 2,000 daily calories and women 1,600, depending on physical activity. But your vitamin and mineral requirements stay the same or may even increase—which can make it a challenge to get the nutrients you need from a smaller calorie intake.

So, MyPlate for Older Adults provides examples of foods that contain high levels of vitamins and minerals per serving. These choices are also consistent with the dietary guidelines, which recommend limiting foods high in trans and saturated fats, salt, and added sugars.

Nutrient-Rich Choices

Not surprisingly, MyPlate for Older Adults spotlights vegetables, fruits, and whole grains as healthy food choices that are convenient, affordable, and readily available. Half of MyPlate for Older Adults is made up of fruit and vegetable icons, which reflects the importance of eating several servings of fruits and vegetables per day in a range of colors.

Consuming a variety of produce with deep-colored flesh, such as peaches, berries, tomatoes, kale, and sweet potatoes, introduces a larger amount of plant-based chemicals, nutrients, and fiber into your diet. MyPlate for Older Adults also includes icons representing frozen, pre-peeled fresh, dried, and certain low-sodium, low-sugar canned options. That’s because fruits and vegetables in those forms contain as many or more nutrients as fresh and they are easier to prepare, are more affordable, and have a longer shelf life—all important considerations for older consumers.

Grains, Protein, Fats

MyPlate for Older Adults features whole, enriched, and fortified grains because they are high in fiber and other beneficial nutrients. Experts advise making at least half your grain choices whole grains.

Suggested protein sources include fish and lean meat as well as plant-based options, such as beans and tofu. For cooking and serving, the Tufts experts recommend vegetable oils and soft spreads (free of trans fats—check the label) as alternatives to foods high in animal fats because animal-based products, such as butter and lard, are higher in saturated fat.

Less Sodium Safer for Your Brain

Other icons represent regular physical activity, emphasize adequate fluid intake, and focus on seasoning with herbs and spices instead of salt. You can also cut down on salt by choosing the low-sodium options of items such as canned vegetables, and draining and rinsing canned beans.

Watching sodium intake is important for older people, not only for heart health but also because of the danger high blood pressure presents to the brain. “Blood pressure tends to increase as we age, so it is especially important for older adults to monitor dietary salt and, for most of us, try to find ways to decrease intake,” says Tufts’ Alice Lichtenstein, DSc, director of Tufts’ HNRCA Cardiovascular Nutrition Laboratory.

DASH to Brain Health

We’ve already mentioned the DASH eating plan, which was developed to target high blood pressure. It makes sense that such a regimen could also benefit your brain, because of the close connection between your cardiovascular system and your brain.

Research titled the Cache County (Utah) Study on Memory, Health and Aging showed that even partly adhering to a DASH plan pays off for cognitive protection. None of the 3,831 participants was actually able to stick to the prescribed diet all the time—but those who came the closest also kept their brains the sharpest. The DASH regimen is high in fruits, vegetables, and grains, while cutting back on meat, saturated fat, sweets, and salt.

Participants in the study were divided into five groups, ranked by how closely their diet matched the DASH goals. Participants were tested using the Modified Mini-Mental State Examination (MMMSE), a standard cognitive measurement; those in the top DASH group scored higher at baseline and even higher after 11 years than those in the least-DASH-adherent group.

The results suggest that including whole grains, vegetables, low-fat dairy foods, and nuts in the diet may offer benefits for cognition in later life, researchers commented. “Over the years, researchers have tried to slow cognitive decline using single nutrients and supplements, with mixed results. We believe that what we have observed is that the total DASH-like diet is greater than the sum of its parts,” researchers noted.

Eating Like a Mediterranean

Another healthy dietary pattern we’ve already mentioned is the so-called “Mediterranean diet” (see Box 2-3, “Mediterranean Diet Pyramid,” and Box 2-4, “Defining the Mediterranean Diet”). Following this traditional dietary pattern typically consumed in Mediterranean countries has been shown to have cardiovascular benefits. But research shows that the Mediterranean diet also seems to be good for your brain.

For example, a 2015 review of the evidence published in Advances in Nutrition supported the theory that following a Mediterranean-style diet can result in lower incidence of cognitive decline, dementia, and Alzheimer’s disease. (Less research has been done on other dietary patterns; however, the authors also pointed to promising studies that examined the effects of patterns such as the Japanese diet and the Healthy Diet Indicator developed by the World Health Organization.) In general, the dietary patterns linked to cognitive protection share common elements, researchers noted: an emphasis on fruits, vegetables, and fish, with limited consumption of meat, saturated fats, and refined sugar.

The Evidence Adds Up

Studies specifically focused on the Mediterranean diet keep adding to this evidence. Data on 17,478 participants in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, average age 64, revealed that healthy people eating more Mediterranean-style diets were 19 percent less likely to develop cognitive impairment over four years. That meant consuming more fish and plant products while eating less red meat and dairy.

Earlier, Columbia University researchers found that subjects who adhered to a Mediterranean-style eating plan were at lower risk of Alzheimer’s disease. The regimen consisted mostly of vegetables, legumes, fruits, whole-grain cereals, and some fish, and was high in monounsaturated fats and low in saturated fat, meat, and dairy. Even after adjusting for demographics and known risk factors, one-third of the individuals in the study who followed the Mediterranean-style diet most closely had about a 40 percent reduced risk of developing Alzheimer’s compared to the group with the lowest adherence. Each additional unit of adherence to a Mediterranean diet (measured on a 0-9 scale) was associated with a nine-to-10 percent reduction in Alzheimer’s risk.

More recent Columbia research has reported that the brains of people sticking to a Mediterranean diet are cognitively “younger” (see Box 2-5, “Can A Mediterranean Diet Keep Your Brain Younger).

Bad Choices for Your Brain

Of course, if healthy dietary patterns and lifestyle choices can help protect your aging brain, it makes sense that bad habits are similarly bad for your brain. For example, one 17-year study of more than 5,000 English adults found that those with the unhealthiest behaviors were nearly three times more likely to suffer impairments in thinking and twice as likely to have memory problems as those with the healthiest lifestyles.

The study looked at the associations between cognition and four behaviors known to have negative overall health effects:

Smoking
Low fruit and vegetable consumption, defined as eating fewer than two servings of fruits and vegetables per day
Lack of physical activity
Alcohol abstinence versus moderate alcohol consumption, defined as drinking between 1 and 14 alcoholic beverages per week.

Compared to those with no unhealthy behaviors, those with three or four bad habits at early midlife were 84 percent more likely to have poor cognitive function 17 years later. As participants got older, the association between unhealthy behaviors and poor cognitive function was even stronger—nearly double.

You might think of smoking as primarily damaging to your lungs, but smoking was also the single-worst habit for the brain. Current smokers scored lowest on memory, verbal, and math-related thinking and reasoning skills at each of three assessment points—early midlife (average age 44), midlife (56) and late midlife (61).

Other Red Flags

While moderate alcohol consumption can be a healthy habit for some, another study points to the dangers of overdoing it: Middle-age men who averaged two-and-a-half or more drinks daily showed faster 10-year declines in cognitive function than did lighter drinkers. The same association was not seen in women, however.

Even a habit as seemingly benign as blasting your food with high heat might be bad for your brain. In a study published in 2015 in the Journal of Alzheimer’s Disease, researchers reported that chemicals called advanced glycation end products (AGEs), formed when foods are cooked at high temperatures, may contribute to the risk of developing Alzheimer’s. Scientists used dietary survey data on the consumption of various foods to calculate that diets containing larger quantities of AGEs—especially from meats—correlated with higher incidence of Alzheimer’s.

The study could only estimate AGE content, however, based on typical food preparations and the tendency of AGEs to form in certain foods. Researchers cautioned that other mechanisms could be responsible for the association, such as the fact that meat is also a source of saturated fat, which contributes to unhealthy cholesterol levels. To be on the safe side, turn down the temperature, avoid charring, and opt more often for braising meats in liquid.

Obesity and Cognition

Another unhealthy factor for your brain, not surprisingly, is being overweight or obese. A growing body of research links excess weight—an important risk factor for heart disease—to cognitive decline and dementia.

For example, a 10-year British study of 6,401 participants, initially ages 39 to 63, found an association between being overweight or obese and impaired cognitive function. When combined with other health issues, such as diabetes or high cholesterol, extra weight also increased the odds of mental decline over time. Researchers speculated that vascular problems associated with weight might affect brain function, along with fat-related secretions that impact the aging brain.

How do you know if you’re at risk? Body mass index (BMI) is one common measure that compares your weight to your height (see Box 2-6, “What Is Your BMI?”). Some research has shown that the ratio of your waist to your hip measurement may be a more accurate measure of cardiovascular risk, although this hasn’t been well tested for similar cognitive risks. Simply measuring your waistline, as if choosing the right pants size, also is a good general rule suggested by the American Heart Association and National Heart, Lung and Blood Institute: Men should aim for a waist size less than 40 inches; women, less than 35 inches.

Exercise Plus Weight Loss

The good news about excess weight is that losing it—especially combined with adding exercise—can benefit your brain. An earlier study in the American Journal of Clinical Nutrition tested the cognitive benefits of a weight-loss diet, an exercise program, and dieting plus exercise among 107 frail, obese older adults for one year. Compared to a control group, all three regimens generally improved cognitive performance, though results varied by test.

But the combination of diet plus exercise was associated with the greatest improvement in scores on the Modified Mini-Mental State Examination (MMMSE), word fluency testing, and two “trail making” tests of visual attention and task switching. Exercise alone boosted MMMSE and word fluency scores about the same as when combined with dieting.

Cutting Calories and Portions

Actively cutting down on calories—not simply “watching your weight”—might also be an effective strategy against cognitive decline. One German study found a connection between a restricted-calorie diet and improved memory among 50 men and women, ages 50 to 72, who were divided into three groups: One group aimed to reduce calorie intake by 30 percent, mostly by eating smaller portions; a second group kept calories the same while increasing intake of healthy fats by 20 percent; and a third, the control group, made no dietary changes.

At the end of three months, the calorie-cutting group scored an average of 20 percent better in tests of memory performance; the other groups showed no change. Researchers theorized that the calorie-cutters, who lost four to seven pounds, might experience brain benefits from decreased insulin and inflammation.

In another study, researchers compared the calorie intakes of 163 older people suffering mild cognitive impairment (MCI) with 1,070 normal control subjects. Those consuming the most calories—more than 2,143 per day—were almost twice as likely to have MCI than participants eating the least, fewer than 1,526 daily calories. The higher the amount of calories consumed each day, the higher the risk of MCI. The results were the same after adjusting for history of stroke, diabetes, amount of education, and other factors that can affect risk of memory loss.

Blood Sugar and Your Brain

Excess weight, especially around the middle (“belly fat”), also affects your blood sugar levels, potentially leading to diabetes. Chronically high blood glucose (sugar) levels, whether from insulin resistance, prediabetes, or type 2 diabetes, seem also to affect the brain. In one study, for example, higher blood glucose was linked with a 40 percent greater risk of developing dementia. Blood glucose levels of diabetics who developed dementia over seven years averaged 190 mg/dl, compared to 160 mg/dl in those who did not develop dementia. (Normal fasting glucose levels are below 100 mg/dl, and levels above 126 mg/dl are considered diabetes.)

People whose blood glucose is higher than normal but not high enough to meet the criteria for diabetes are also at greater risk. That same study found that people with the highest levels—but short of diabetes—were 20 percent more likely to develop dementia than those with normal blood glucose levels. Among non-diabetic participants, those who developed dementia had blood sugar levels averaging 115 mg/dl, compared with 109 mg/dl for those who did not develop dementia.

Carbs and Blood Sugar

In addition to keeping your weight in check, you can reduce your diabetes risk and help control your blood sugar by making smart choices about carbohydrates—another aspect of a healthy dietary pattern. Recently, a large observational study linked starch consumption to greater risk of type 2 diabetes in women. Foods with a higher ratio of starch to fiber include processed and refined grain products, such as white rice, crackers, many ready-to-eat breakfast cereals, and bread and pasta that’s not made from whole grains. Some vegetables, such as white potatoes and corn, are also high in starch. Intakes of total fiber, cereal fiber, and fruit fiber were all associated with lower diabetes risk, emphasizing the importance of making smart carbohydrate choices in your diet.

You can still enjoy eating while consuming a healthy dietary pattern. It will help, though, if you can learn to savor a beautifully prepared piece of fish at least as much as a juicy steak, or to appreciate a dessert of fresh berries as much as a slice of cake. Healthy food can still be delicious, as the sample recipes in the back of this book demonstrate.

You can even enjoy an occasional indulgence, as long as you stick to the plan and your healthy dietary pattern over the long haul. The healthy foods we’ll be exploring in the later chapters of this book will give you plenty of options that are as good for your taste buds as for your brain.

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