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9 Signs That You're Not Eating Enough

Achieving and maintaining a moderate weight can be challenging, especially in a modern society where food is constantly available.

However, not eating enough calories can also be a concern, whether it’s due to intentional food restriction, decreased appetite, or other reasons.

In fact, under-eating on a regular basis can lead to a number of mental, physical, and emotional health issues. Here are nine signs that you’re not eating enough.

1. Low Energy Levels

Calories are units of energy your body uses to function.

When you don’t eat enough calories, you’re likely to feel tired most of the time.

The number of calories needed for these basic functions within a 24-hour period is referred to as your resting metabolic rate.

Most people have a resting metabolic rate higher than 1,000 calories per day. Adding physical activity can increase your daily needs by another 1,000 calories or more.

Although hormones also play a role in energy balance.

Generally, if you take in more calories than needed, you will store most of the excess as fat. If you take in fewer calories than needed, you will lose weight (1).

Restricting intake to fewer than 1,000 calories daily can slow down your metabolic rate and lead to fatigue since you’re not taking in enough calories to support the basic functions that keep you alive.

Eating too little has particularly been linked to low energy levels in older people, whose food intake may decrease due to reduced appetite (2).

Other studies on female athletes have found that fatigue may occur when calorie intake is too low to support a high level of physical activity. This seems to be most common in sports that emphasize thinness, like gymnastics and figure skating (3, 4).

Even light physical activity like walking or taking the stairs may cause you to tire easily if your calorie intake is well below your needs.

Summary:

Eating too few calories can lead to fatigue due to insufficient energy to exercise or perform movement beyond basic functions.

2. Hair Loss

Losing hair can be very distressing.

It’s expected to lose several strands of hair daily. However, if you’re noticing an increased amount of hair accumulating in your hairbrush or shower drain, it may be a sign that you’re not eating enough.

Many nutrients are needed to maintain routine, healthy hair growth.

Inadequate intake of calories, protein, biotin, iron, and other nutrients is a common cause of hair loss (5, 6, 7, 8, 9).

Basically, when you don’t take in enough calories and key nutrients, your body will prioritize the health of your heart, brain, and other organs over hair growth.

Summary:

Hair loss may occur as a result of inadequate intake of calories, protein, and certain vitamins and minerals.

3. Constant Hunger

Being hungry all the time is one of the more obvious signs that you’re not eating enough food.

Studies confirm that appetite and food cravings increase in response to drastic calorie restriction due to changes in levels of hormones that control hunger and fullness (10, 11, 12, 13).

One three-month study followed mice that were fed a diet containing 40% fewer calories than usual.

It found that their levels of appetite-suppressing hormones leptin and IGF-1 decreased and hunger signals increased significantly (10).

In humans, calorie restriction may cause hunger and food cravings in both moderate-weight and overweight individuals.

In a study of 58 adults, consuming a 40%-calorie-restricted diet increased hunger levels by about 18% (11).

What’s more, low calorie intake has been shown to increase the production of cortisol, a stress hormone that has been linked to hunger and increased belly fat (14, 15).

Essentially, if your calorie intake drops too much, your body will send signals that drive you to eat in order to avoid potential starvation.

Summary:

Undereating can cause hormonal shifts that increase hunger in order to compensate for inadequate calorie and nutrient intake.

4. Problems Trying to Get Pregnant

Undereating may interfere with a woman’s ability to become pregnant.

The hypothalamus and pituitary gland located in your brain work together to maintain hormonal balance, including reproductive health.

The hypothalamus receives signals from your body that let it know when hormone levels need to be adjusted.

Based on the signals it receives, the hypothalamus produces hormones that either stimulate or inhibit the production of estrogen, progesterone, and other hormones by your pituitary gland.

Research has shown that this complex system is highly sensitive to changes in calorie intake and weight (13).

When your calorie intake or body fat percentage drops too low, signals may become impaired, leading to changes in the number of hormones released.

Without the proper balance of reproductive hormones, pregnancy cannot take place. The first sign of this is hypothalamic amenorrhea, or having no menstrual period for six months or longer (15).

In an older study, when 36 underweight women with amenorrhea or infertility related to calorie restriction increased their calorie intake and achieved ideal body weight, 90% began menstruating and 73% became pregnant (17).

If you are trying to conceive, make sure to consume a well-balanced, adequate-calorie diet in order to ensure proper hormonal function and healthy pregnancy.

Summary:

Consuming too few calories can disrupt reproductive hormone signals, leading to difficulty getting pregnant.

5. Sleep Issues

Sleep deprivation has been found to lead to insulin resistance and weight gain in dozens of studies (18).

In addition, while overeating may cause sleeping difficulty, it appears that strict dieting can lead to sleep problems as well.

Animal and human research has shown that starvation-level calorie restriction leads to sleep interruptions and a reduction in slow-wave sleep, also known as deep sleep (19).

In one study of 381 college students, restrictive diets and other eating problems were linked to poor sleep quality and low mood (20).

In another small study of 9 young women, four weeks of dieting led to greater difficulty falling asleep and a decrease in the amount of time spent in deep sleep (21).

Feeling as though you are too hungry to fall asleep or waking up hungry are major signs that you’re not getting enough to eat.

Summary:

Undereating has been linked to poor quality sleep, including taking longer to fall asleep and spending less time in deep sleep.

6. Irritability

If little things have begun to set you off, it could be related to not eating enough.

Indeed, irritability was one of several issues experienced by young men who underwent calorie restriction as part of the Minnesota Starvation Experiment during World War II (22).

These men developed moodiness and other symptoms while consuming an average of 1,800 calories per day, which was classified as “semi-starvation” for their own calorie needs. Your own needs may be lower, of course.

A more recent study of 413 college and high school students also found that irritability was associated with dieting and restrictive eating patterns (23).

To keep your mood on an even keel, don’t let your calories drop too low.

Summary:

Prolonged low calorie intake and restrictive eating patterns have been linked to irritability and moodiness.

7. Feeling Cold All the Time

If you constantly feel cold, not eating enough food could be the cause.

Your body needs to burn a certain number of calories in order to create heat and maintain a healthy, comfortable body temperature.

In fact, even mild calorie restriction has been shown to lower core body temperature.

In a six-year controlled study of 72 middle-aged adults, those who consumed an average of 1,769 calories daily had significantly lower body temperatures than the groups who consumed 2,300–2,900 calories, regardless of physical activity (24).

In a separate analysis of the same study, the calorie-restricted group experienced a decrease in T3 thyroid hormone levels, whereas the other groups did not. T3 is a hormone that helps maintain body temperature, among other functions (25).

In another study of 15 obese women, T3 levels decreased by as much as 66% during an eight-week period in which the women consumed only 400 calories per day (26).

Overall, the more severely you slash calories, the colder you’re likely to feel.

Summary:

Consuming too few calories can lead to a decrease in body temperature, which may be due in part to lower levels of T3 thyroid hormone.

8. Constipation

Infrequent bowel movements may be related to inadequate calorie intake.

This isn’t surprising, since consuming very little food will result in less waste in your digestive tract.

Constipation is typically described as having fewer than three bowel movements per week or having small, hard stools that are difficult to pass. This is very common in older people and can be worsened by poor diet (27).

One small study of 18 older adults found that constipation occurred most often in those who didn’t consume enough calories. This was true even if they got plenty of fiber, often considered the most important factor for proper bowel function (28).

Dieting and eating too little food may also cause constipation in younger people due to a slowed metabolic rate.

In a study of 301 college-aged women, the strictest dieters were most likely to have constipation and other digestive problems (29).

If you’re having problems with regularity, it’s important to take a look at the amount of food that you’re eating and evaluate whether you’re getting enough.

Summary:

Strict dieting and under-eating can lead to constipation, partly due to less waste product to form stool and slower movement of food through the digestive tract.

9. Anxiety

Although dieting itself may lead to moodiness, outright anxiety can occur in response to very low calorie intake.

In a large study of more than 2,500 Australian teens, 62% of those who were classified as “extreme dieters” reported high levels of depression and anxiety (30).

Anxiety has also been observed in people who are overweight and eat very low calorie diets.

In a controlled study of 67 people with obesity who ate either 400 or 800 calories per day for one to three months, roughly 20% of people in both groups reported increased anxiety (31).

To minimize anxiety while trying to lose weight, make sure you’re consuming enough calories and eating a healthy diet that includes plenty of fatty fish to ensure you’re getting omega-3 fatty acids, which may help reduce anxiety (32).

Summary:

Very low calorie intake may lead to moodiness, anxiety, and depression in teens and adults.

The Bottom Line

Although overeating increases the risk of developing health problems, under-eating can also be problematic.

This is especially true with severe or chronic calorie restriction. Instead, to lose weight sustainably, make sure to eat at least 1,200 calories per day.

Additionally, be on the lookout for these nine signs that you may need more food than you’re currently taking in.

Dear Reader,

Stroll down the aisles of your supermarket, and you will see a burgeoning array of food products that claim to be healthy. But which foods are actually best for your health? We’ll give you a hint. If your diet consists mainly of packaged foods or meat, it’s probably not the healthiest for your health—or the health of the planet. As scientific research continues to affirm, the dietary patterns that are most closely linked to a longer, healthier life tend to focus more on whole plant foods—that is, unprocessed or minimally processed foods like fruits, vegetables, legumes, whole grains, and nuts. A plant-based diet is also linked with far lower energy and water use and greenhouse gas emissions than a meat-heavy diet—a boon for the planet.

In January 2016, the USDA and the U.S. Department of Health and Human Services released the 2015–2020 version of the Dietary Guidelines for Americans—the culmination of our na tion’s top nutrition experts’ efforts to review the body of nutrition science and create dietary recommendations that have the potential to make Americans stronger and healthier. The com mittee stressed the importance of eating more whole plant foods, as well as fish and healthy fats. When you fill your diet with more plant foods—such as steel-cut oats, pinto beans, blueberries, almonds, and spinach—you not only gain vitamins, minerals, fiber, and hundreds of healthful compounds called phytochemicals. You also crowd out of your diet less healthful processed foods, such as sugary beverages, doughnuts, and cookies, which have been linked with obesity, heart disease, high blood pressure, and type 2 diabetes. Even processed or cured meats such as bologna and bacon are more problematic than, say, minimally processed fish. In 2015, the World Health Organization classified cured and processed meats as potentially cancer-causing.

But healthy eating goes beyond nutrition. How you eat food—whether you eat in front of your computer screen or in the car versus sitting down and savoring your meals in the company of others—makes a difference, too. The more you pay attention to the complex flavors, textures, and aromas of your food, the greater the satisfaction you will reap. As a result, you can be con tent with less food than if you mindlessly devour a bag of chips while watching TV.

As nutrition researchers, we have spent years learning to understand both the positive and nega tive effects that food can have on the human body. And in the pages of this report, we will show you just how easy it is to achieve a simple, wholesome eating pattern that can help you live a longer, healthier life. Bon appétit!

Sincerely,

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

Sharon Palmer, M.S.F.S., R.D.N. Nutrition Editor

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A healthy eating style

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Yes, this plan involves eating more vegetables— and, as you may have guessed, it doesn’t include a lot of packaged snacks or fast food. But once you know how to pre pare healthy meals, you’ll find they can be much more tasty than highly processed foods. As Dr. Willett says, just think

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flicting information can make it difficult to dis tinguish scientifically

Conflicting reports in the news media make it seem as if views on good nutrition are changing all the time. Nothing could be further from the truth. The consensus has been growing in recent decades.

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backed nutrition advice from marketing and hype. And news headlines can make it seem as if views on good nutrition are changing all the time.

Nothing could be further from the truth. The optimal diet for good health, low disease risk, healthy weight, and long life has been a matter of growing consensus over the last several decades, thanks to a hard-earned body of evidence.

Moreover, the power of this healthful diet is becoming clearer over time. “When we began our research on diet and health in the late 1970s, we had a general sense that diet was likely to be important in the prevention of heart disease and cancer,” says Dr. Walter Willett, past chair of the Department of Nutri

tion at Harvard T.H. Chan School of Public Health. What he and other researchers found was that it did exactly that—and more. “Aspects of diet play a role in the prevention of disease and dysfunction in almost every organ of the body,” he says. In addition to low

ering your blood pressure, total cholesterol, and risks of certain types of cancer, it can help ward off strokes, diabetes, cognitive decline, osteoporosis, kidney prob lems, certain gastrointestinal problems, various eye diseases, and so on down a long list.

olive oil, perfectly seasoned with herbs and spices. Add in a hunk of hearty whole-grain bread and an entree of fresh grilled fish, and you can readily imag ine just how satisfying this whole-foods diet can be. Now compare that with greasy burgers and chips at the local diner. “It’s junk food that’s tasteless, requiring large amounts of added salt, sugar, and fat to make it palatable,” he says.

If you’re convinced, then there’s no time like the present to start remaking your diet. You have noth ing to lose—except perhaps a few unwanted pounds and points off your cholesterol and blood pressure numbers. This chapter and those that follow will help explain in greater depth how to accomplish this.

In search of a healthy diet

Fats were once demonized. Today, carbohydrates are the targets of choice for many people. However, the quest for a healthy diet does not begin with drastically reducing either one. In fact, fat, carbs, and protein all play important roles in the body. Collectively, these three food components are known as macronutrients because the body requires relatively large amounts of

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each of them (as opposed to micronutrients—essential vitamins and minerals—which are needed in much smaller amounts). It follows from this understanding that the key to a healthy diet does not hinge on elimi

nating any of them, but on picking the best sources of all three. In popular terminology, there are “good” and “bad” carbs. Similarly, there are healthful and not so-healthful sources of fat and protein. The more you can tilt your diet in favor of the beneficial ones while

reducing the others, the better off you’ll be. Sorting out one from the other may sound like a daunting task, but it’s easier than you’d think. The first rule of thumb is simply to stick with what nutri tionists call “whole” foods as much as possible—that is, foods that are unprocessed or minimally processed (see “Choose whole foods first,” below). We don’t mean you should eat everything raw. Cooking is fine. But start with real ingredients—fruits, vegetables, nuts, whole grains, fish, eggs, and skinless poultry. The more a food has been processed before you purchase it, the more goodness has likely been stripped away. The second rule of thumb is to increase the amount of plant foods in your diet (see “Focus on plants,” page 4). Most Americans eat far more meat than they need and not nearly enough vegetables or fruits. The third rule of thumb, of course, is to limit your calories, so that you don’t put on a lot of excess weight. The writer Michael Pollan summed up these points neatly in the opening of his 2008 book In Defense of Food: An Eater’s Manifesto: “Eat food. Not too much. Mostly plants.”

Choose whole foods first

Why do researchers and nutritionists place so much emphasis on whole foods? It’s actually quite simple. You gain the most benefit from foods when you con sume them in their whole or minimally processed form—the form that comes closest to matching their natural state when harvested. In unprocessed form, fruits, vegetables, legumes, nuts, and whole grains contain a wealth of vital nutrients, such as fiber, vita

mins, minerals, and phytochemicals (compounds with antioxidant and anti-inflammatory effects). In fact, there are thousands of phytochemicals in plants, with new ones being discovered all the time. These com

pounds not only provide health benefits, but also work together in networks to provide even greater effects. Unfortunately, many of them are stripped away in the processing of foods.

Even healthful foods, such as spinach, whole wheat, and beets, become less nourishing when they are processed so heavily that they hardly resemble their original selves. Some examples are the spin

ach in “vegetable” chips, the wheat in “wheat” bread made from refined flour, and the beet sugar used in candy bars. These plant foods start out as something wholesome and healthful, thanks to their cache of hard-working fiber, vitamins, minerals, and phyto

chemicals. In their whole form, they have the power to help protect your eyes, heart, brain, and more. Yet when they are peeled, ground up, juiced, and stripped of various components—as they are in many pro

cessed foods—they lose a great deal of those valuable nutrients. The peel and seeds are usually lost—and these, along with the fibrous pulp, are often the most highly concentrated sources of nutrients in the entire plant.

Processing may also degrade sensitive nutrients in the plant, such as vitamin C and many of the B vitamins. And when these processed ingredients are combined to form new foods—such as chips, crack

ers, cookies, desserts, and beverages—refined sugars, sodium, and fats are often added to the mix. So what do you end up with? A serving of highly caloric food with few nutrients in return. Just walk down the aisle of a supermarket or peruse the menu at a fast-food restaurant and you’ll see many examples of such foods: sugary cereals made of processed grains; salty chips made of peeled, fried potatoes; and juice drinks and fruit turnovers made with refined fruits and sugars.

That’s why it’s so important to focus on nutri ent-rich, whole foods. That means choosing oranges instead of orange juice, wheat berries instead of white bread, and steamed zucchini instead of deep-fried zucchini wedges. The principle even carries over to fish and poultry, where you’ll do better to focus on fish fillets rather than battered, fried, preformed fish sticks, or a chicken breast rather than chicken nug

gets. You’ll find most of these highly processed foods in packages, boxes, bags, and drive-throughs. By con

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trast, whole foods, such as a bunch of kale, an apple, a scoop of barley kernels, and a handful of peanuts, don’t often come in splashy packages and boxes. They may not even come in a package at all—a good indica

tor of a whole food. Purchase most of your foods in their whole form for optimal health.

Focus on plants

Packing your plate with more plant foods than animal foods may protect you from disease, lengthen your life, and help you maintain a healthy weight, according to a number of important studies. A large trial called EPIC (European Prospective Investigation into Cancer and Nutrition), which included more than 74,000 adults, found that closer adherence to a plant-based diet was linked with lower risk of death during the nearly 15 years of the study.

Why are plant foods so beneficial for your health? As noted earlier, they are rich in fiber, vitamins, min erals, healthy fats, and phytochemicals. Moreover, when you eat more of these plant foods, they tend to replace less healthful foods in your diet, such as fatty red and processed meats and high-fat dairy.

However, the quality of a plant-based diet is also important. Diets that emphasize minimally processed plant foods are more healthful than those that include large amounts of refined foods, even if they’re plant

based. One study that included nearly 48,000 women and 26,000 men over a 12-year period analyzed peo ple’s dietary patterns according to their overall con sumption of plant-based foods and also whether that consumption consisted of healthful, unrefined plant based foods or lower-quality, refined ones, such as fruit juices and French fries. A 10-point increase in score on the healthy plant-based diet scale was linked with a 10% lower risk of death from cardiovascular disease, while a 10-point increase in score on the unhealthy plant-based diet scale was linked with a 6% higher risk.

A plant-based diet can be as tasty as it is healthful. But if you’ve never eaten this way, it can be challenging at first to figure out how to do it. Here are some tips to help you get started. You’ll find more later, in the chapter “Putting it all together,” page 31, plus a selec

tion of healthy recipes in the Special Section starting on page 43.

• Turn your favorite meat-based meals into plant based ones. If you like lasagna, try eliminating the ground beef and substituting mushrooms and spinach. Skip the beef in your burritos in favor of pinto beans.

• Find easy recipes for at least a few meatless meals and try to have one or two each week; over time, you can aim to make half your meals meatless. Good options are vegetarian chili and veggie burg

ers (see “Chipotle Black Bean Quinoa Veggie Burg ers,” page 47).

• Instead of animal protein, eat at least 3 cups a week of protein-rich legumes, such as beans, len tils, and peas. There are many ways to enjoy them. Toss chickpeas into a salad, add beans to a stew, or include lentils in a loaf.

• Include more whole soy foods—another good source of plant-based protein. Snack on dry roasted edamame, which you can buy in ready-to-eat pack ages in many supermarkets. Add tofu instead of chopped chicken or turkey to your favorite casse role or other recipe (see “Stir-Fried Thai Tofu Sor ghum Bowl,” page 47). Find a brand of soy burger to replace ground beef in your bun—looking for those that have fewer artificial ingredients and more whole ingredients, such as vegetables, grains, and beans.

• Combine simmered whole grains, sautéed or raw vegetables, and cooked legumes on your plate. This age-old combination provides the perfect combina tion of proteins and nutrients to fuel your body.

The Dietary Guidelines for Americans The U.S. government provides nutrition guidance for Americans that is updated every five years by the USDA and the U.S. Department of Health and Human Services. The Dietary Guidelines for Ameri

cans represent the work of a committee of scientists who analyze reams of nutritional research as it relates to national health problems, such as our high rates of obesity, cardiovascular disease, cancer, and diabe

tes. They debate the evidence and ultimately make recommendations to the government. As such, the guidelines distill the latest nutritional research and translate it into practical advice.

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The 2015–2020 Dietary Guidelines for Americans— the latest version at the time of this printing—provide advice similar to what you will read in this report. The guidelines encourage people to consume more whole or minimally processed plant foods with the aim of reducing disease risk, combating obesity, and meeting nutritional needs for optimal health. To that end, they recommend one of three healthful eating plans:

• a healthy U.S.-style dietary pattern, which focuses on plenty of fruits, vegetables, and whole grains with moderate amounts of lean meat and poultry, seafood, and low-fat dairy products

• a healthy vegetarian-style pattern, which includes lots of fruits, vegetables, legumes, whole grains, low-fat dairy, and soy foods

• a healthy Mediterranean-style pattern, which includes a bounty of fruits, vegetables, whole grains, legumes, fish, nuts, seeds, and olive oil.

What do all three have in common? They all focus on whole and minimally processed plant foods, such

Figure 1: How to read food labels

as whole grains, legumes, nuts, seeds, and healthy fats. Following are some of the main take-home messages from the Dietary Guidelines. You’ll find more about all of these topics later in this report.

Foods to reduce

The notion that you will simply eliminate all unhealth ful foods and ingredients from your diet is unrealistic, but the following guidelines give you some targets to aim for.

• Reduce daily sodium intake to less than 2,300 mil ligrams to help control your blood pressure. Fur ther reduction of sodium to no more than 1,500 milligrams per day may be beneficial for even bet ter effects on blood pressure, and is recommended for people who have high blood pressure (hyperten sion) or prehypertension. Avoiding processed foods is one way to limit salt intake, since 80% of the salt in the average diet is not from what you add in your kitchen or at the table, but what is contained in pack

Most of the truly healthful foods like fruits and vegetables don’t have nutrition labels on them. Packaged foods, on the other hand, do, and reading the label is your most reliable guide to choosing the best options. The FDA has recently required changes on the label that will make it easier to read. Large manufacturers have to start using the revamped label by Jan. 1, 2020, and smaller companies, by 2021.

The refreshed design lists calories

per serving in larger, bolder type.

Serving sizes are also highlighted and

changed to reflect the amounts of

food people actually eat. For example, instead of a soda serving being 8 ounces, the new label lists 12. Instead of an ice cream serving being ½ cup, it lists 2/3 cup.

“Calories from fat” has been removed from its previous position opposite calories per serving, but the new label still gives a breakdown of total fat, saturated fat, and trans fat, so you can easily see how much of the total fat is from less healthful sources.

For the first time, the label includes a line about added sugars, so you can see how many grams of sweeteners have been added to foods during processing—as opposed to the naturally occurring sugars in a tomato product, for example.

For the first time, actual amounts of vitamins and minerals are listed, along with the Daily Values for each one.

Daily Values have been updated to reflect the latest recommendations for nutrients like sodium, dietary fiber, and vitamin D.

Vitamins A and C are no longer listed; the FDA says deficiencies of these vitamins are rare. Taking their places on the label: potassium and vitamin D, since the FDA says most people aren’t getting enough of those nutrients.

The footnote has been changed to give a clearer explanation of Daily Values.

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aged, prepared, and processed foods. Use spices and herbs rather than salt to make food more flavorful. • Consume less than 10% of calories from saturated fats. These fats are found in animal products such as butter, cream, cheese, and fatty meats, and also in tropical oils, such as palm, palm kernel, and coco nut oils. Instead, try replacing them with mono unsaturated and polyunsaturated fats, such as healthier vegetable oils, olives, nuts, seeds, and avo cados. Red meat, such as beef, pork, and lamb, tends to be higher in saturated fat, so it’s best to limit your consumption of these. (Editors’ note: According to the American Institute for Cancer Research, you should also avoid cured and processed meats, such as ham, sausage, and bacon.)

• Limit added sugars to no more than 10% of total calories (about 50 grams or 12.5 teaspoons of sugar for the average person). The new Nutrition Facts label can help you find them (see Figure 1, page 5).

• Limit the consumption of foods that contain refined grains, such as white flour and white rice, especially those products that contain high amounts of satu rated fat, added sugars, and sodium.

• If you drink alcohol, do so in moderation, meaning no more than one drink per day for women and two drinks per day for men. Saving all your drinking for the weekend means that you take in unhealthy amounts of alcohol at a single sitting. Women who are pregnant and people under the legal drinking age should not drink at all.

Foods to increase

While you focus on reducing your consumption of the foods named above, here’s what you should aim to replace them with. It may not be what you’re used to eating, but over time, you will find that such fare is actually more satisfying.

• Increase your vegetable and fruit intake. Adults should consume about 2½ to 3 cups of vegetables and 1½ to 2 cups of fruit per day. A 2017 report from the CDC found that only about 12% of adults meet the target for fruit, and just 9% meet the goal for vegetables.

• Also focus on increasing the variety of produce you consume. Eating a broad range of fruits and vegeta

bles—especially dark green, red, and orange ones— will ensure that you also take in a broad range of nutrients.

• Make sure that at least half the grains you consume are whole grains (such as brown rice, barley, or qui noa) rather than refined grains (such as white bread and white rice).

• Choose more plant-based proteins, such as beans, peas, lentils, nuts, seeds, and soy foods, including tofu, tempeh, and soy milk.

• Make healthier animal protein choices, including seafood (at least twice a week), poultry, and eggs. • Use healthy vegetable oils to replace solid fats where possible.

• Choose foods that provide more potassium, fiber, calcium, and vitamin D, which are nutrients that many Americans don’t get enough of (see “Shortfall nutrients,” page 26). These foods include vegetables, fruits, whole grains, legumes, nuts, seeds, seafood, and milk and milk products.

Harvard’s Healthy Eating Plate By now you know generally what types of food a healthy diet includes. But it can take time to reframe your mental image of a healthy meal. Over the years, many of us have become used to thinking of the hunk of meat in the center of our plates as “dinner.” The salad or vegetables on the side were fine add-ons, but not the star attraction. Changing your dinner plate starts with changing your idea of what a plateful of healthy food should look like. In 2011, the U.S. Department of Agriculture (USDA) introduced MyPlate—a graphic representation of the ideal dinner. It moved protein to the side of the plate and gave larger roles to veg etables, fruits, and grains. However, for many people, this model (which is still in use) proved too simplistic to be useful.

To provide a more helpful illustration, nutrition experts at Harvard developed their own Healthy Eat ing Plate (see Figure 2, page 7). The Healthy Eating Plate gives you basic guidance on food choices and shows you how to apportion foods on your plate. Of course, not every meal will look like this (most of us don’t eat vegetables at breakfast), but your meals over

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the course of the day can add up to this goal. Here is a summary of the main points:

• Fully half your plate should contain fruits and veg etables. While you’re at it, aim for a variety of colors and types. (Note that for these purposes, potatoes— including French fries—don’t count as vegetables.)

• A quarter of the plate should be filled with whole grains—not just any grain. Whole and intact grains, such as barley, quinoa, oats, and brown rice, are good choices.

• The final quarter should consist of healthful sources of protein, like fish, beans, nuts, seeds, poultry, and eggs. High-fat meats and processed or cured meats don’t appear here. And red meat and cheese should be limited.

• The bottle on the left side is a reminder to use healthy oils like olive and canola in cooking, on sal ads, and at the table. Limit butter.

Figure 2: Harvard’s Healthy Eating Plate

• The glass on the right side is a reminder to drink low- or no-calorie liquids like water, coffee, and tea. Skip sugary drinks, and limit milk to one or two servings per day.

At the bottom is a reminder to stay active for good health and weight control.

Other models of science-based guidelines are also available. You can find eating guides adapted to Medi terranean, Latin American, Asian, African, and veg etarian diets from the respected nutrition think tank Oldways, at www.oldwayspt.org.

Sustainability on the plate

If you follow the guidelines in this chapter, your health will benefit. But there is another plus to this healthful, whole-foods diet—the health of our planet. A plant based diet with only small amounts of animal foods

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requires a fraction of the resources such as water, energy, and land to cultivate, and it generates fewer greenhouse gases. What’s more, by eating unprocessed or minimally processed foods, you avoid the addi

tional energy and packaging that go into the produc tion of processed foods.

In fact, adopting a plant-based diet may be the single most important way that you as an individual can reduce your carbon footprint. According to a 2019 study in The American Journal of Clinical Nutrition, diets high in red meat account for five times the emis

sions of plant-based diets.

How much plant food should you aim for if you want a truly sustainable diet? In early 2019, the EAT Lancet Commission on Food, Planet, and Health—a multidisciplinary group consisting of 37 leading sci entists from 16 countries—described the type of diet needed to support a world population of 10 billion by the year 2050 in a healthful, sustainable way. Its report urged people to double the amount of fruits, vegeta bles, and nuts they eat and reduce consumption of red meat and added sugars by at least 50%. While its rec ommendations are quite a departure from what most

Figure 3: The Planetary Health Plate

Americans eat—allowing for only a single 3.5-ounce serving of red meat per week—proponents point out that this is in line with a traditional Mediterranean eating pattern. The commission included a graphic representation of its “planetary health plate” that shows just how much of a person’s overall diet should come from plant-based sources (see Figure 3, below).

Here are some additional ways to make your meals more sustainable:

• Purchase more foods that are grown closer to home to reduce the number of miles your food has to travel to get to your plate. Also eat more foods that are in season, so that they are not trucked or flown in from faraway places.

• Avoid food waste. Every time you throw away food, gallons of water, fossil fuels, and agricultural inputs used to grow the food go in the trash, too.

• Avoid excessive food packaging. Buy from bulk bins, farmers’ markets, and produce sections to favor minimally packaged foods. Bring your own shopping bags to the supermarket, your own food containers to restaurants to pack up left

overs, and your own coffee mug to the coffee shop. • Don’t use bottled water. Fossil

fuels are used in producing and

transporting them. And count

The EAT-Lancet Commission uses this plate to illustrate a dietary pattern (as opposed to a single meal) that can sustain both human and environmental health. Half the plate is filled with

vegetables and fruits. The other half is

filled with whole grains, plant protein,

unsaturated plant oils, and (optionally)

modest amounts of animal protein,

including fish.

Source: EAT Foundation.

less bottles end up in landfills. Bring a refillable water bot tle for on-the-road hydration.

• Grow your own food. Even if it’s just a tomato plant or a pot of basil, try to produce some of your own food to reduce food transportation.

• Buy organic, when possible. Organic foods are grown without the use of synthetic herbicides, pesticides, and fungicides that kill off many life forms in soil—good and bad alike. Pesticides threaten pollinators (like bees and butter flies) and beneficial insects (such as ladybugs and praying man

tises). (See “Are organics worth it?” on page 35.)

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Choosing healthful carbohydrates

Carbs have gotten a bad reputation, taking a beat ing from proponents of both the Paleo diet (which recommends eating more meat and no grains) and the ketogenic (“keto”) diet (which emphasizes high fat, low-carb fare). However, carbohydrate-rich foods are important for your health. Carbohydrates, which are found in a wide range of healthful foods (as well

as not-so-healthful foods), provide your body with a source of energy to fuel your daily activities. And carb-containing foods, such as whole grains, vegeta bles, fruits, and legumes, are rich in other important nutrients your body needs, including fiber, vitamins, and minerals. If you significantly reduce your intake

of carbs, you will likely fall short on these nutrients. That’s why a set of guidelines

Dietary alphabet soup: What are RDAs, DRIs, and DVs? Most people have heard of Recommended Dietary Allowances (RDAs). But how do they differ from DRIs and DVs? Here’s some help.

known as the acceptable macronutri ent distribution ranges, or AMDRs (see “Dietary alphabet soup,” at left), recommend that your daily menu

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

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

for Americans and food labeling regulations. They include RDAs, ULs (upper tolerable limits), AIs, and AMDRs (see below).

Adequate intake (AI): This value is used to indicate a level of sufficient consumption for nutrients such as vitamin K, manganese, and potassium that are not associated with a specific clinical deficiency disease.

Acceptable macronutrient distribution range (AMDR): This is the range of intake for a particular macronutrient—fat, carbohydrate, or protein—that is associated with reduced risk of chronic disease while allowing intake of essential nutrients.

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

should supply 45% to 65% of your calories from carbohydrates. If you include fruits, vegetables, and whole grains at each meal and snack, you’ll easily achieve this level of healthy carbohydrates.

The important thing, then, isn’t to avoid carbs in general, but to pay more attention to the types of carbs you choose.

“Good” carbs

What puts a carb-containing food on the “good” list? When you consume a diet that’s rich in minimally pro cessed or whole carbohydrate-rich foods, such as whole grains, legumes, vegetables, and fruits, you gain all of the rewards of those nutrients they are packaged with, namely fiber, vita

mins, minerals, and phytochemicals. Most people intuitively grasp that fruits and vegetables are healthful. But what about whole grains? These constitute one of most misunder stood food groups in this category,

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Figure 4: Whole-grain anatomy

Endosperm

Bran

Germ

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

Source: Oldways Whole Grains Council.

thanks to a number of popular diets that bash grains in general, including whole grains. So let’s set the record straight.

Whole grains

Hundreds of studies link a dietary pattern rich in whole grains with a plethora of health benefits, includ ing a reduced risk of many chronic diseases. In fact, in 2019 The Lancet published a series of analyses of more than 200 studies investigating the relationship of whole-grain and fiber intake to disease protection. The researchers found that whole-grain intake and fiber intake were both linked to significantly lower risk of heart disease, strokes, type 2 diabetes, colorec

tal cancer, and death. People who ate the most whole grains enjoyed the greatest benefits.

Why are these simple plant foods—essentially the seeds of grasses—so protective? One reason is the fiber rich outer covering called bran (see Figure 4, above), which slows the breakdown of starch into glucose and helps the body maintain a steady blood sugar level. Fiber—particularly the soluble fiber found in barley, oatmeal, beans, nuts, and fruits like apples, berries, cit

rus fruits, and pears—also helps lower cholesterol and move food through your digestive tract. The embryo, or germ, is equally important, containing a wealth of vitamins and minerals, as you can see if you read the Nutrition Facts on a package of wheat germ. Among these nutrients are essential B vitamins and minerals like magnesium, selenium, and copper. If you were to completely eliminate whole grains from your diet—as some fad diets suggest—you’d fall short on many key nutrients needed for optimal health.

When looking for whole grains, do not limit your search to whole-wheat bread and crackers, which have undergone processing and contain varying levels of actual whole grains (see “In search of whole grains,” page 11). Many whole grains, such as brown rice and quinoa, can be eaten intact. These grains actually form a diverse category of foods with varying flavors, tex tures, and nutrients. Here’s a list of whole grains to try.

Amaranth. This ancient grain of the Aztecs is a small, beige seed with a mild flavor. Rich in calcium and iron, it is a gluten-free grain and good in por ridge, added to pilafs, or ground into whole-grain flour for baking.

Barley. Rich in a special type of fiber, called beta glucans, barley has special heart-health benefits related to its ability to lower blood cholesterol levels. While barley is well known as an ingredient in soup, this chewy grain is equally delicious in casseroles, side dishes, and salads. Choose hulled barley (available as grains, grits, flakes, or flour) over pearl barley, which has been processed to remove the bran.

Buckwheat. Not a true wheat, buckwheat is actu ally a cousin to rhubarb and is naturally gluten-free. Its nutty flavor can contribute to much more than pan cakes; try it cooked as a grain (also known as kasha) in salads, side dishes, or soups. Soba is a traditional Japa nese noodle that uses buckwheat as a key ingredient.

Millet. This grain may be tiny, but it’s mighty, serving as a staple food in many cultures in India and South America, among others. It’s delicious cooked in cereals and desserts, and is ground into flour for breads, such as Indian roti.

Oats. Another source of the rare group of fibers called beta glucans, oats (when eaten daily) have been linked with significantly lower blood cholesterol

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levels. But oats can go beyond the breakfast table in dishes like veggie burgers, risotto, breads, and fruit based desserts.

Quinoa. This staple grain from the Andes is high in nutritional value, having served as a revered food among the Incas for thousands of years. Mild and quick-cooking, it’s delicious in side dishes, salads, and vegetable fillings.

Rice. Brown, colored (black, purple, or red), and wild rice are all whole grains (although wild rice is not a true rice). This mild-flavored grain, which serves as a blank canvas for nutritious vegetable-rich toppings, is a major source of nutrients to millions of people around the world.

Rye. A natural part of the cuisine in Northern Europe and Russia, rye is predominantly featured in whole-grain breads. However, whole rye grains— called rye berries—are delicious steamed and served as porridge, a side dish, or a filling for vegetables.

Sorghum. With roots in Africa, this whole grain is quite nutritious and may be served as porridge, ground into flour for breads, or even popped like popcorn.

Teff. The tiniest of grains, teff resembles reddish brown poppy seeds. Yet these petite grains pack a nutritional wallop, serving as a staple in Ethiopia where they are the main ingredient in the fermented

Don’t assume that whole-wheat bread and brown rice are your only options when it comes to whole grains. Quinoa is a nutrious grain that cooks quickly. Farro, millet, barley, and oats are other choices.

bread injera. Teff is also delicious in cereals, grain side dishes, and baked goods.

Wheat. Though we’re most familiar with wheat as a flour, it also comes in other forms, such as bulgur (used in Middle Eastern salads), farro (an ancient Ital ian variety of wheat traditionally cooked in its intact form), spelt (a variety of wheat), and wheat berries (cooked, intact wheat kernels).

Fiber

Aside from vitamins, minerals, and phytochemicals, fiber is one of the reasons why a diet rich in “good” carbs is so healthy. It is actually a form of indigestible

In search of whole grains

It’s easy to tell that you’re eating whole grains when

you serve cooked oats, barley, and brown rice, but it gets a bit more complicated when you’re selecting foods that contain whole grains, such as breads, side dishes, and baked goods. Packaging may call attention to a product’s “whole grains,” even if the product contains very little whole grain.

There are a couple of ways to help solve this problem. First, scan the ingredients list and make sure that one or more whole grains, such as whole-wheat flour, oats, cornmeal, or brown rice, appear first on the list, indicating that they have the largest volume by weight in the food. Next, take a look at the grams of fiber on the Nutrition Facts panel. Most true whole-grain products should provide at least 3 grams of fiber per serving—but keep in mind that this may not always tell you the true picture. In some cases, isolated fibers, such as inulin, are added to foods to bring up the fiber levels. And some whole grains, such as brown rice, contain more modest levels of fiber than other whole grains, such as whole wheat or barley. Remember, all whole grains are good for you, so choose a variety every day.

Another way is to look for the Oldways

Whole Grains Council logos, which

identify foods that provide at least

half a serving of whole grains. These

seals (which look like gold-and-black

postage stamps) may be found on

hundreds of food products, guiding

you to whole-grain food choices in the

supermarket aisle.

Source: Oldways Whole Grains Council.

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carbohydrate found in plant foods. But though you can’t digest it—and therefore it isn’t absorbed into your bloodstream—fiber does many useful things while it’s in your digestive tract. Among its many benefits:

• It slows down digestion and lowers a food’s glyce mic index value, a measure of how quickly the sugar in the food enters your bloodstream (see “Glycemic index and glycemic load,” page 13).

• It helps you feel more full for a longer period of time, thus helping to control appetite and weight. • It slightly reduces “bad” LDL cholesterol. • It reduces insulin resistance.

• It promotes bowel health.

• It can support a healthy gut microbiome—an eco system of healthy gut microorganisms, which can promote overall health and well-being.

A high-fiber diet correlates with lower rates of heart disease, type 2 diabe

asparagus), pectin (found in apples, carrots, and apri cots), and resistant starch (found in grains, legumes, and potatoes).

How much fiber should you aim for? For people up to age 50, the recommended intake for fiber is 38 grams for men and 25 grams for women (unless they are pregnant or breastfeeding, in which case the recommendations go up to 28 grams and 29 grams, respectively). The recommendation is lower for people over age 50: 30 grams for men, 21 grams for women. That’s because older people require less food as their energy needs decline. Sadly, Americans fall short on fiber, consuming on average only about 15 grams of fiber a day.

As with other nutrients, fiber is healthiest when it comes from whole foods rather than processed ones. Some “high-fiber” products on store shelves are filled with isolated fibers, such

tes, and obesity, as well as better appetite control and digestive function. There’s also some evidence that it might reduce the risk for duodenal ulcers, breast can

cer, and ovarian cancer, but more studies are needed. Some fibers act as prebi otics, meaning they promote the growth or activity of “good” bacteria in the colon (see “Powering up with pro biotics,” page 38). The bac teria feed on these fibers and cause them to ferment, producing compounds that help the body regulate appe tite, metabolism, and glu cose. Prebiotics include guar gum (found in legumes), inulin (found in artichokes, asparagus, chicory, garlic, leeks, and wheat), fructooli gosaccharides (found in a variety of fruits and vegeta bles, including bananas and

Table 1: High-fiber foods
FOOD	FIBER (GRAMS)
Flaxseed (1 ounce)	8
Lentils, cooked (½ cup)	8
Minestrone soup (1 cup)*	7
Artichokes, cooked (½ cup)	7
Chickpeas, cooked (½ cup)	6
Pear (1 small)	5
Raspberries (½ cup)	4
Almonds (1 ounce)	4
Orange (1 large)	4
Figs, dried (2)	4
Whole-grain bread (1 slice)*	3
Snow peas, fresh (1 cup)	3
Banana (1 small)	3
Whole-wheat spaghetti, cooked (½ cup)	3
Quinoa, cooked (½ cup)	3
Broccoli, cooked (½ cup)	3
Whole-grain hot cereal, cooked (½ cup)*	2
Peanut butter (2 tablespoons)	2
Walnuts (1 ounce)	2
Amount of fiber varies based on brand. Source: USDA National Nutrient Database for Standard Reference.*

as inulin, which is added to many food products to increase the total volume of fiber. While inulin is a pre

biotic, it is not linked with the multitude of health ben efits found in whole plant foods that are naturally rich in fiber. So prioritize whole food fiber sources in your diet.

It’s easy to meet your fiber goals if you’re loading up on whole plant foods— especially legumes and whole grains. But fruits, vegetables, nuts, and seeds are also good sources. (See Table 1, at left, for a list of foods that are naturally high in fiber.) Every gram counts toward your goal. Note that if your intake of fiber is low and you increase it dramati

cally, you may notice some gastrointestinal symptoms at first.

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“Bad” carbs

“Bad” carbs are those that are highly processed, such as refined grains (white flour, white rice), fruit juices, and sug

ars (from beets, cane, or corn, for example). During the course of processing, they are stripped of many of their nutrients—in particular vitamins, miner

als, phytochemicals, and fiber. s

Without that fiber, the natural

starches and sugars are digested

more quickly, and are therefore

absorbed into the bloodstream

more rapidly in the form of ©

glucose. That’s one reason why a glass of orange juice isn’t as good for you as a whole orange. While most of the poor

Doughnuts may tempt you with sprinkles and icing. But they are made with refined sugar and flour, are digested very quickly, and can make your blood sugar spike shortly after you eat them.

Glycemic index and glycemic load

“Bad” carbs are typically digested more quickly than good carbs—a fact that is reflected in a measurement called the gly

cemic index (GI). In general, highly processed carbohydrate containing foods, such as white bagels, sugary beverages, and white rice, have a higher GI, while minimally processed car bohydrate-containing foods, such as wheat berries, beans,

and spinach, have a low GI. The problem with high-GI foods eaten in isolation is that they tend to flood your blood stream with sugar all at once, triggering a gush of insulin to

carb choices tend to be highly refined foods, some are not. Take potatoes. Baked potatoes with the skins are whole plant foods that contain good amounts of potassium and vitamin C, along with some fiber, but potatoes have a high glycemic index, meaning they raise blood sugar rapidly (see “Glycemic index and glycemic load,” above right). Potatoes have also been linked with higher weight, so they should be limited to more moderate consumption. “Quick-cooking” whole grains are another whole food that can be prob lematic, since the processing needed to reduce their cooking time can raise their glycemic index value.

So which foods are on the “bad” carb list? The fol lowing should be limited in the diet:

• foods made with large amounts of refined sug ars (including table sugar and high-fructose corn syrup, among others), such as many types of des serts, ice cream, pastries, doughnuts, flavored yo gurt, beverages, and cereals

• foods made with refined (white) flour, such as breads, bagels, crackers, and other baked goods • white potatoes

• white rice

• quick-cooking oats or grits

• fruit juice.

clear the sugar from your blood and leaving your blood sugar too low after just a few hours. This can make you feel hungry, which can lead to overeating and weight gain. Over time, a steady diet of high-GI meals may impair your body’s system of responding to insulin, causing a problem known as insulin resis

tance, which in turn can lead to type 2 diabetes and other problems, such as heart disease and perhaps some cancers.

However, the glycemic index doesn’t provide a perfect gauge of what happens when you actually eat a meal. For example, if you eat a mixed meal con taining both high- and low-GI foods, as well as some protein and fat, the sugar rush is blunted. In addi tion, numerous factors can influence the GI of a food, such as ripeness, variety, and preparation method. And people may have a unique, individual glycemic response to foods that can even vary during certain times of the day.

More important, GI numbers can be misleading. For example, carrots have a high GI, meaning that the sugar from them hits your bloodstream quickly, but because they contain so few total carbohydrates over all, the amount of sugar you get from them in a normal serving size is not a problem. That’s where

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Table 2: How much sugar are you really eating? You expect to find sugar in your ice cream and pound cake. But many other foods contain added sugar, too—from fruit smoothies to bread, tomato sauce, and yogurt—and these sugars can add up quickly. Here are some examples. Note that while food labels are beginning to include “added sugars,” this information is not yet available for some products as well as for restaurant foods and beverages.
FOOD	TOTAL SUGAR (GRAMS)	TOTAL SUGAR (TEASPOONS)*	ADDED SUGAR (GRAMS)
Starbucks Caramel Frappuccino, tall (12 ounces), with whipped cream	46	11	Not available
Pepsi (12-ounce can)	41	10	41
Snapple Peach Tea (16-ounce bottle)	40	10	40
Coca-Cola (12-ounce can)	39	9	39
Panera Strawberry Banana Smoothie (16 ounces)	38	9	Not available
Gatorade Original Thirst Quencher (20-ounce bottle)	34	8	34
McDonald’s Fruit ’N Yogurt Parfait (5.2 ounces)	28	7	Not available
PowerBar Performance Energy, Chocolate (65-gram bar)	26	6	Not available
Clif Bar, Blueberry Crisp (68-gram bar)	22	5	Not available
Yoplait Original Mixed Berry Yogurt (6-ounce container)	19	5	Not available
Sara Lee Pound Cake (76 grams)	19	5	Not available
Tillamook California Peach, 2% Farmstyle Greek Yogurt (5.3-ounce container)	16	4	12
Luna Protein, Chocolate Salted Caramel (45-gram bar)	15	4	15
Capri Sun Fruit Punch (6-ounce pouch)	13	3	Not available
Bertolli Tomato and Basil Pasta Sauce (½ cup)	11	3	Not available
Pillsbury Blueberry Toaster Strudel (55-gram pastry)	10	2	Not available
Thomas Blueberry Bagel (95-gram bagel)	9	2	Not available
Prego Traditional Pasta Sauce (½ cup)	9	2	4
Thomas Cinnamon Raisin English Muffin (61-gram muffin)	7	2	Not available
1 teaspoon of sugar is equivalent to 4.2 grams of sugar; values are rounded to the nearest whole number. Source: Company websites and product packaging.*

another measurement called the gly cemic load (GL) comes into play. GL takes into consideration the amount of carbohydrates you typically con sume in a serving of food, in addi tion to how quickly those carbs are digested. Carrots have a high GI but a low GL, making the GL a much more accurate picture of their glyce mic impact.

To achieve a low-GL diet, avoid highly processed carb-containing foods and try to make a higher pro portion of your carbs intact grains, legumes, whole fruits, and vegeta bles. Following are some suggestions: • Skip fruit juice and instead focus

on whole, unsweetened fruits, such as oranges, apples, and berries. • Replace quick-cooking oats and grits with steel-cut oats and whole grain porridges.

• Limit intake of sugar-sweetened pies, cakes, or cookies. Instead, enjoy unsweetened yogurt with ripe berries or chopped fruit.

• Swap out white rice for bulgur, quinoa, or hulled barley.

• Trade white bread for whole-grain, whole-kernel, or “flourless” breads made with legumes.

• Instead of baked or mashed white potatoes, choose roasted, cubed sweet potatoes.

Added sugars

Once upon a time, the only sugars we consumed were those naturally pres ent in the foods we ate—the sugars found in tomatoes or blueberries, for example. But then humans learned how to extract sugar from sugar cane and beets, and they began adding it to foods. Nutritionists use the term “added sugars” to refer to these sug

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ars, which pile on calories and raise blood glucose lev els with no added nutritional value.

Nutritious or not, we love the sweet stuff. It seems that everywhere you turn, you see foods with added sugar, from sugary sodas and energy drinks in the gas station, to muffins and cookies in the coffee shop, to candy and doughnuts in the vending machine at work. Not surprisingly, this can contribute a lot of daily calo

ries to a person’s diet. The average intake of added sug

ars is 17.4 teaspoons a day (73 grams) for Americans

ages 2 and older, according to data from the National

Health and Nutrition Examination Survey. This

amount is even higher (25.1 teaspoons, or 105 grams) ©

among people who do not meet overall recommenda tions in the Dietary Guidelines. Research suggests that increased intake of added sugars is linked with obe sity, metabolic disorders, and cardiovascular disease.

How much sugar is too much? The Dietary Guide lines now recommend limiting added sugar to 10% of your calories—and the American Heart Association sets an even lower target of just 5% of total calories. Even using the higher level, that’s only 200 calories for someone who consumes 2,000 calories a day—or about 12.5 teaspoons of added sugar each day for the average person. (A teaspoon of sugar is 4.2 grams.) That’s not much, when you consider how much sugar is added to foods. To keep sugar in check, your best bet is to enjoy most of your foods in their whole or minimally processed form and to limit your con

sumption of packaged foods, prepared entrees, baked goods, and fast foods.

It’s also important to keep an eye out for “hidden” sugar in foods, which can add up quickly. It’s easy to predict that added sugar will be in sweet things, like sodas, cookies, and cakes. But there is also a lot of added sugar in many products that sound healthy, such as tomato sauce, yogurt (which can be as sweet as ice cream), granola bars (often as sugary as candy bars), and breakfast cereals (see Table 2, page 14).

The FDA has approved new food labels (see Fig ure 1, page 5). These labels indicate how much added

Nutritious or not, we love the sweet stuff. Food manufacturers know that, and they sneak sugar into products that sound healthy, like tomato sauce, yogurt, and granola bars. Always check labels for sugar.

sugar a food has. That helps you distinguish between the natural sugars present in foods and those that have been added as sweeteners. You can also check the ingredients list of a food product to find added sugars. Steer clear of products that list sugar, honey, molas

ses, corn syrup, corn sugar, fructose, or high-fructose corn syrup, since those are clearly added—and espe cially avoid foods that list multiple forms of sugars or include a sugar among the first three ingredients, indicating that the product contains a lot. Other sugar aliases to watch for include agave nectar, brown sugar, cane sugar, corn sweetener, dextrose, maltose, fruit juice concentrate, brown rice syrup, and glucose.

Note that while “natural” sugars such as agave, coconut palm sugar, and honey are growing in pop ularity because they are considered less processed than cane or beet sugar, they are still added sugars and should be limited. In addition, low-calorie or no-calorie sweeteners such as stevia, aspartame, and sucralose are present in many food products, such as yogurt and beverages. While these sweeteners don’t add sugar to meals and appear to be safe, they aren’t always linked with effective weight control. You’re better off enjoying the natural flavor of foods without the addition of sweeteners.

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Finding the best fats

A few decades ago, people feared fats, which were

thought to make you fat, as well as raise your risk of disease. But in recent years, scientists and nutrition ists have been re-evaluating the role of fats in the diet. Now we know that, as far as health is concerned, the important thing is not so much the amount of fat, but the type of fat you choose. While the wrong ones can clog your arteries and lead to heart disease, the right kinds can actually lower your risk of cardiovascular trouble. That helps explain why the Mediterranean diet—which is rich in healthful fats, such as olive oil and those found in nuts and fish—is so good for you.

Fat is actually an essential element of the diet. It’s a major source of energy, helping to fuel your activities, insulate your body, and keep you warm. In addition, the body requires fat to make cell membranes, sheath nerves, maintain healthy skin and hair, and perform other vital functions. Fat even aids in the absorption of certain key nutrients from food. For example, you need to consume some fat in order for your body to absorb the fat-soluble vitamins—vitamins A, D, E, and K—from the digestive tract into your bloodstream.

At the same time, fat slows the absorption of sugar and other refined carbs from your digestive tract. If you guzzle a tub of fat-free ice cream on an empty stomach, there is nothing to hinder the rush of sugar from your digestive tract into your bloodstream. But fat slows down the process. That’s a positive thing, because it means that your body isn’t hit with a surge of sugar all at once, but can absorb it more gradually.

As for weight gain, the role of fat is paradoxical. True, each gram of fat contains 9 calories, as opposed to just 4 calories per gram for carbohydrates and proteins, so a little goes a long way. If you overload on fats on a regular basis, you can easily increase your calorie intake and end up gaining weight. Yet the plethora of fat-free products that swamped the market a few decades ago didn’t lead to weight loss. In part, that’s because the fat free label made people assume they could eat a lot of

these products. But it’s also because fat has the virtue of making food taste better and keeps you fuller longer, so you’re inclined to be more satisfied with less food.

That’s not carte blanche to load up on fat. Aim to get 20% to 35% of your daily calories in the form of fat. Just two to three servings of foods with healthy fats each day—a serving being a handful of nuts or seeds, 2 tablespoons of nut butter or seed butter, half an avocado, or food cooked with 1 tablespoon of olive oil—will put you at the lower end of that range.

“Good” fats

Like carbohydrates, fats can be divided into more healthful and less healthful types. In general, the “bad” fats come from animal sources and tropical oils. The so-called good fats come mostly from vegetables, nuts, and fish. You can easily spot them because they are liquid at room temperature.

There are two categories of healthy fats: polyun saturated and monounsaturated.

Polyunsaturated fats

Fish oil, flaxseeds, and sunflower seeds are all sources of the healthy group of fats known as polyunsaturated fatty acids (see Table 3, page 17). Polyunsaturated fats are essential in your diet, meaning that your body can’t manufacture them, so you must get them from food. These fats are required for normal body func

tion, including brain development, inflammation con trol, and blood clotting. These fats are also important components of cell membranes, affecting the structure and properties of the cell. Some of these fats are found in very high concentrations in cells in the retina and brain. They also help reduce total and LDL (bad) cho lesterol and triglycerides, if substituted for saturated fat and carbs, respectively. There are two major types of polyunsaturated fats—omega-3 fatty acids and omega-6 fatty acids. Both offer health benefits.

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Omega-3 fatty acids. These can consist of either longer or shorter chains of carbon, hydrogen, and other atoms. Research has shown that the long-chain omega-3s in fish and fish oil—specifically, eicosa

pentaenoic acid (EPA) and docosahexaenoic acid (DHA)—help prevent and even treat heart disease and stroke. These fats help reduce blood pressure, lower triglycerides, and prevent heart rhythm disorders, and may raise HDL (good) cholesterol. Evidence also sug

gests they help reduce the need for anti-inflammatory medications in people with rheumatoid arthritis. Fatty fish, such as salmon, mackerel, and sardines, are espe cially good sources of omega-3s.

Of course, you can buy omega-3 supplements, too. However, a recent analysis of 79 clinical trials found supplementation had little impact on cardiovascu lar disease risk. A better bet for heart health is to eat actual foods that contain omega-3s. If you eat fish

and other seafood, for example, you not only gain the healthy fats together with other beneficial compounds present in the food, but you also replace something on your plate—often something less healthy, such as red or processed meat.

While the most helpful omega-3s are the long chain ones found in seafood, there is also a shorter chain omega-3 fatty acid, called alpha-linolenic acid (ALA), that is found in some plants, such as flaxseeds, walnuts, chia, canola oil, and soy. Studies have linked ALA with a reduced risk of certain heart conditions and inflammatory diseases. The body can also convert ALA into the long-chain omega-3s—EPA and DHA. However, it is not very efficient at doing this, so to ensure that you get enough EPA and DHA, you should consume them in your diet regularly. The adequate intake (AI; see “Dietary alphabet soup,” page 9) for ALA is 1.6 grams per day for men and 1.1 for women.

Table 3: Plant foods containing healthy fats In whole foods, various types of fat are rarely found in isolation. Nuts, seeds, and olives all contain mixtures of fats, including healthful monounsaturated fatty acids, polyunsaturated fatty acids, and alpha-linolenic acid (ALA), along with saturated fat. Although saturated fat is generally regarded as a less healthful form of fat, it is more than balanced out in plant-based foods by the higher levels of healthy fats.
FOOD (1-OUNCE SERVING)	CALORIES	TOTAL FAT	SATURATED FAT	MONOUNSATURATES	POLYUNSATURATES	OMEGA-3S (ALA)
Almonds	169	15 g	1 g	10 g	4 g	0 mg
Avocado	50	5 g	1 g	3 g	1 g	33 mg
Brazil nuts	185	19 g	4 g	7 g	6 g	5 mg
Cashews	155	12 g	2 g	7 g	2 g	17 mg
Chia seeds	137	9 g	1 g	1 g	7 g	4,915 mg
Flaxseeds	150	12 g	1 g	2 g	8 g	6,388 mg
Hazelnuts	181	18 g	1 g	13 g	2 g	17 mg
Hemp seeds	160	12 g	1 g	1 g	9 g	2,264 mg
Macadamia nuts	203	22 g	3 g	17 g	0 g	55 mg
Olives, ripe, canned	32	3 g	0 g	2 g	0 g	18 mg
Peanuts	164	14 g	2 g	7 g	4 g	1 mg
Pecans	199	21 g	2 g	12 g	6 g	278 mg
Pine nuts	190	19 g	1 g	5 g	10 g	32 mg
Pistachios	157	13 g	2 g	7 g	4 g	72 mg
Pumpkin seeds	153	13 g	3 g	4 g	6 g	51 mg
Sesame seeds	160	14 g	2 g	5 g	6 g	105 mg
Sunflower seeds	163	14 g	2 g	3 g	9 g	19 mg
Walnuts	185	18 g	2 g	3 g	13 g	2,565 mg
Source: USDA National Nutrient Database for Standard Reference.

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No AI has been established for EPA and DHA. Omega-6 fatty acids. These fats get relatively little attention in the media, but they may help pro tect against heart disease, too. Research shows that replacing saturated fats with polyunsaturated ones, including omega-6 fatty acids, consistently lowers levels of LDL cholesterol—and a pooled analysis of studies found that replacing 5% of total energy intake of saturated fats with omega-6s could reduce the risk of heart attacks, strokes, and similar events by 13% and heart-related deaths by 26%. Linoleic acid, the omega-6 that appears to lower LDL the most, can be found in abundance in such veg etable oils as safflower, soybean, sunflower, walnut, and corn oils. These are good oils to use for sautéing foods, making salad dressings, and baking. (Be aware, how ever, that high-oleic safflower and sunflower oils, often used in chips, have much lower omega-6 content.) The AI for linoleic acid is 17 grams per day for men ages 19 to 50, 14 grams for men 51 to 70, 12 grams for women 19 to 50, and 11 grams for women 51 to 70. However, omega-6s, which are also plentiful in processed foods, can end up crowding out healthful omega-3s, if you aren’t careful. You can improve your ratio of omega-3 fats to omega-6 fats in your diet by prioritizing omega-3 food sources such as seafood, soy foods, walnuts, chia seeds, and flaxseeds, and reducing your intake of highly processed foods.

Monounsaturated fats

Olive oil is probably the most famous example of a rich source of monounsaturated fats. While there’s no dietary reference intake (DRI) for these fats, the Dietary Guidelines recommend using them as much as possible, along with polyunsaturated fats, to replace saturated fats in the diet. Monounsaturated fats decrease the risk of cardiovascular disease and type 2 diabetes because they help improve blood cholesterol levels and your body’s responsiveness to insulin. In addition, extra-virgin olive oil, which is cold-pressed and unrefined, contains plant compounds with anti inflammatory activities. Other good sources of mono

unsaturated fats include olives, canola oil, avocados, and most nuts (and their oils), as well as high-oleic safflower and sunflower oils (look for the words “high

oleic” on the label). All you have to do is look to the Mediterranean diet pattern, with hundreds of studies showing health benefits, to see an example of an eating approach rich in monounsaturated fats.

“Bad” fats

Just as there are healthy fats, so are there unhealthy fats—namely, saturated fats and artificial trans fats. Such fats boost your chances of developing heart dis

Table 4: Foods high in saturated fat The following are examples of food products that are high in saturated fat. Eating too many of them can easily put you over your daily allowance.
FOOD (PER SINGLE ORDER OR ITEM UNLESS OTHERWISE NOTED)	SATURATED FAT (GRAMS)	% DAILY VALUE
Outback Steakhouse Aussie Cheese Fries, large	51	255%
PF Chang’s Thai Harvest Curry with Chicken	43	215%
KFC Chunky Chicken Pot Pie	25	125%
Del Taco Macho Combo Burrito	20	100%
Domino’s Chicken Carbonara Pasta	18	90%
Beef short ribs (3.5 ounces)	18	90%
Croissant with egg, cheese, sausage*	18	90%
Pork chop (3.5 ounces)	10	50%
Burger King Bacon Double Cheeseburger	10	50%
Au gratin potatoes (1 cup)*	9	45%
Cheesecake (one-sixth)*	8	40%
Butter (1 tablespoon)	7	36%
Fruit Danish*	7	35%
Heavy cream (1 ounce)	7	35%
Cheddar cheese (1 ounce)	6	29%
Cream cheese (1 ounce)	6	29%
Reese’s Sticks (1.5 ounces)	5	25%
Banquet Salisbury Steak Dinner	5	23%
Whole milk (1 cup)	5	23%
Bacon, pan-fried (1 ounce)	4	20%
May vary depending on product. Sources: USDA National Nutrient Database for Standard Reference; restaurant websites.*

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ease by increasing blood levels of LDL cholesterol and triglycerides. That’s why the Dietary Guidelines rec ommend avoiding them in your diet—and why the FDA banned artificial trans fats from food products (although some naturally occurring ones remain).

Saturated fats

Saturated fat has been the subject of much debate recently, thanks to headlines hinting that these fats are no longer the bad boys of heart health. Unfor tunately, a controversial meta-analysis published in Annals of Internal Medicine in 2014—which is often cited as “proof ” that saturated fats are not bad—is rife with errors and omissions. The analysis, which drew on data from multiple earlier studies, misconstrued research originally performed by scientists at various institutions, including Harvard’s T.H. Chan School of Public Health. The analysis found that reducing satu

rated fats did not lower heart disease risk, leading to headlines stating that saturated fat wasn’t bad for the heart after all—but many of the participants in these studies had replaced saturated fat with refined carbs, which are just as bad for the heart, blunting the effect of the saturated fat reduction. Furthermore, the anal

ysis omitted data from studies in which people who replaced saturated fats with polyunsaturated fats did reduce their risk for heart disease. In fact, after its ini tial publication, the study was corrected to include

data that showed benefits from omega-3 fatty acids. So, despite news stories suggesting that you don’t need to worry about saturated fat, it’s a good idea to keep levels in your diet low. The Dietary Guidelines, which are based on the entire body of evidence, rec ommend that saturated fat intake remain below 10% of dietary calories—about 22 grams per day for the average person. The American Heart Association recommends aiming even lower, limiting saturated fat intake to just 5% to 6% of total calories—no more than about 13 grams a day for the average person. For perspective, both 3 ounces of regular ground beef and 1 ounce of cheddar cheese have 6 grams of satu rated fat. Saturated fats are primarily found in animal foods, including high-fat meats; high-fat dairy prod ucts, such as cheese, butter, whole milk, and cream (see Table 4, page 18); and tropical fats, such as palm,

What’s up with coconut oil?

Coconut oil is a trendy ingredient, turning up in a

broad range of food products, health food stores, and media stories. Many so-called experts claim that coconut oil is some sort of tonic, good for all sorts of benefits, such as “burning” fat, killing viruses, lowering

cholesterol, and reducing seizures. However, there is little evidence to back up the hype.

Coconut oil is made up of 90% saturated fat, which raises LDL (bad) cholesterol. Indeed, if you see a bottle of coconut oil, you’ll notice that it’s solid at room temperature—a hint that it is high in saturated fat. Some people point to the fact that about half the saturated fat comes in the form of lauric acid, which boosts HDL (good) cholesterol. But, given the dearth of data supporting its use, you’re best off limiting it for now and using healthier vegetable oils, such as olive oil and soybean oil.

palm kernel, and coconut oils (see “What’s up with coconut oil?” above).

Trans fats

Artificial trans fats—the partially hydrogenated oils that were once commonly found in products like crackers, cookies, cakes, frozen pies, snack foods, stick margarines, coffee creamers, refrigerated dough prod

ucts, and ready-to-use frostings—became the poster child for poor nutrition after it became widely known that they had no known nutritional value and no safe level of consumption. In June 2018, an FDA ban on products with artificial trans fats took effect.

That said, some naturally occurring trans fats are found at very low levels in foods such as in beef, lamb, milk, butter, and cheese. It is not clear if the natural trans fats are as harmful as artificial trans fats—in fact, early testing suggests that they aren’t—but since they often keep company with saturated fats, there’s reason to be cautious.

It’s also worth noting that while manufacturers have stopped making products with artificial trans fat, they frequently replace it with ingredients such as palm oil that are high in saturated fat. Other replace

ments include coconut oil, palm kernel oil, shorten ing, and full-fat dairy products, such as whole milk, butter, and cream.

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Picking healthful protein

It seems like everywhere you turn these days, you’re

hearing about the virtues of a protein-rich diet. Pro tein is undeniably important—you need it to maintain your muscles, bones, skin, and every other organ and tissue in your body. It has many functions, including building the enzymes that trigger many of the body’s important chemical reactions. A lack of protein in the diet can slow growth, reduce muscle mass, lower immunity, weaken the heart and respiratory system, and even cause death.

Not only is protein important in your overall diet, but emerging research suggests that you should have some at all three meals to maintain your muscles, especially if you are older. Often people consume little protein in the morning, preferring to pile up on pro

tein during the evening. To prevent this imbalance, try to ensure that you get adequate protein at breakfast, too—for example, from Greek yogurt, eggs, legumes, nuts, seeds, or tofu.

However, you may not need as much protein as you think you do at any given meal. Protein deficiency is rare in the United States and other industrialized countries. In fact, the opposite is often true. Ameri

cans tend to overestimate how much protein they

Beans provide lean protein, plus a healthful bonus of additional nutrients, such as fiber, vitamins, and minerals. As long as you eat a variety of plant proteins, you’ll get all the essential amino acids.

really need. The recommended intake for protein is 10% to 35% of your total calories—that’s a range of 50 to 175 grams of protein per day for the average person, depending on your energy needs—although older people and athletes may need slightly more to maintain their muscles. It’s not difficult to achieve this level of protein intake. Almost all whole foods contain protein—some more than others (see Table 5, below). Protein is even found in whole grains and vegetables. But it’s especially concentrated in foods like meat, fish, poultry, soy, legumes, nuts, and seeds. A few servings of protein-rich foods a day, and you’re there.

The best protein choices

So which types of protein are best? Start by consider ing what else you find in the same food. Along with a healthy complement of minerals, does the food in question pack a hefty dose of unhealthful saturated fat (like ground beef)? Or does it come in a lean food with

Table 5: Good sources of protein These healthful foods contain a hefty amount of protein.
FOOD	PROTEIN (GRAMS)	PERCENTAGE OF CALORIES FROM PROTEIN
Fish, raw (3 ounces)	15	87%
Kidney beans, cooked (1 cup)	15	27%
Low-fat yogurt, plain (8 ounces)	12	33%
Tofu, firm (½ cup)	10	53%
Lentil soup, canned (½ cup)*	9	25%
Nonfat milk (1 cup)	8	39%
Peanuts (1 ounce)	7	18%
Pumpkin seeds (1 ounce)	5	16%
Broccoli, chopped, cooked (½ cup)	2	28%
May vary depending on product. Source: USDA National Nutrient Database for Standard Reference.*

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a healthful bonus of additional nutrients, such as fiber, vitamins, minerals, and phytochemicals (like lentils)? It’s these other considerations that largely determine whether the proteins you put on your plate will help

reduce—or increase—your risk of chronic diseases.

Some people also place a high value on the food’s

complement of amino acids—the building blocks of

proteins. There are 20 amino acids that supply the raw

material for the body’s proteins. Following genetic ©

instructions, the body strings together these amino acids into chains to make the specific proteins it needs. Of the 20, only nine are considered “essential” amino acids. Like the essential fats, these are components the body cannot synthesize and must take in from food.

Proponents of meat-heavy diets often claim that meat is the superior source of protein because it is a “high-quality” protein with significant amounts of all nine essential amino acids. However, you can get all nine by eating a variety of plant foods, such as legumes, soy, and nuts. You may not find signifi

cant amounts together in most individual plant foods (one exception is soy, which has good balances of all nine amino acids, comparable to levels found in ani mal proteins), but as long as you consume a variety of plant foods every day, your body maintains a pool of amino acids to meet your needs.

If you rely on plant foods to supply most of your protein, the easiest way to make sure you get enough of these amino acids is by eating a range of protein containing foods. Many ethnic cuisines do this by pairing grains and legumes. For example, Latin cui sines are often based on rice and beans; any essential components missing from the beans are in the rice. Similarly, in Indian cuisine, rice and dal (lentils) form the basis of many meals. This formula can apply to many pairings, such as farro and white beans or pea nuts and millet, for example. Any range of protein containing plants is likely to supply the nine, so this is not something you should stress over.

In order to fuel your body with the protein it needs while reducing your risk of chronic disease, focus on the following choices.

Legumes. These plant-based foods—including dried beans, lentils, and peas—are not only rich in protein (about 8 grams per half-cup, cooked), but are

The occasional slice of lean beef can deliver a hefty dose of protein and minerals, such as iron and zinc. But research suggests that a regular diet of it boosts the risks for heart disease and some cancers.

also are packed with fiber, folate, manganese, potas sium, iron, magnesium, copper, selenium, zinc, and phytochemicals. Studies have linked consumption of legumes with lower risk of heart disease, high blood pressure, obesity, some types of cancer, and type 2 diabetes. Most cultures once relied on these sustain able, nutritious plant proteins regularly, but in mod ern times our intake has waned. Try to consume more legumes—aim for at least one half-cup serving daily as a replacement for meat on the plate.

Soy. Actually part of the legume family, soy is an important food source traced back to ancient China. It is uniquely rich in high-quality protein (15 grams per half-cup, cooked), as well as iron, calcium, and—when minimally processed—fiber. Soy also possesses phy

toestrogens, which have antioxidant properties that may account for some of soy’s health benefits, such as lower risk of heart disease. Don’t believe the hype you might read on the Internet about the alleged dan

gers of consuming soy. There is no scientific basis for avoiding this wholesome food source in its minimally processed forms if you consume moderate amounts— about two or three servings per day of soy foods, including tofu, tempeh, soybeans, edamame, soy milk, and soy nuts.

Nuts and seeds. Nuts (from almonds to walnuts) and seeds (from chia to sunflower) are packed with plant-based protein—3 to 9 grams per ounce, depend ing on the variety—as well as healthy fats, fiber, vita mins, minerals, and phytochemicals. Research shows that a handful a day (about 1 ounce) can help cut your risk of heart disease. Turn to these nutritional super stars, such as peanuts (technically a legume, but nutri

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tionally similar to nuts), pistachios, and hemp seeds for a source of protein on your plate.

Plant-based meat alternatives. A number of trendy meat alternatives, from the Impossible Burger and Beyond Meat to frozen quinoa burgers, are mak ing a splash in the plant-based protein space. While it’s a good idea to increase plant proteins in your diet, it’s also important to check the Nutrition Facts on many faux meats, which can be just as high in saturated fat and sodium as conventional meat products. You’re best off choosing minimally processed plant proteins, such as tofu, beans, and peanuts.

Fish. The best animal protein you can choose is fatty fish or seafood, which is high in protein and long-chain omega-3 fatty acids (see page 17). Fish consumption has been linked to numerous benefits, including reduced risks of heart attacks, strokes, prostate cancer, depression, and Alzheimer’s disease. That’s why the Dietary Guidelines and the American Heart Association suggest that you include at least

What to do about mercury in fish

two 3-ounce servings of fish or seafood in your diet weekly. Try to choose those that are richest in omega 3s. However, you should also be aware of mercury in fish and try to avoid those with the highest levels (see

“What to do about mercury in fish,” below). Poultry. Skinless chicken and turkey provide good sources of protein, with minimal saturated fat, making it a good protein choice. Include this versatile animal protein in casseroles, stir-fries, salads, and stews.

What about red meat?

An occasional lean steak isn’t a problem. In fact, it can deliver a hefty dose of protein and minerals, such as iron and zinc. However, a growing body of research indicates that diets heavy in red meat may contribute to disease risk, such as certain types of cancer, heart disease, diabetes, and early death. Harvard research

ers analyzed data from the Nurses’ Health Study and the Health Professionals Follow-up Study and found

Fish is an excellent source of protein,

and its healthy oils protect against cardiovascular disease. Because a diet rich in seafood protects the heart and aids neurological development, fish

remains an important component of a healthy diet.

However, nearly all fish and shellfish contain traces of mercury, a toxic metal, and some seafood contains other contaminants known as persistent organic pollutants (POPs). As small fish are eaten by larger fish up the food chain, concentrations of mercury and POPs increase, so that large, predatory deep-ocean fish tend to contain the highest levels. That makes it best to avoid eating large fish, such as shark, swordfish, tilefish, and king mackerel. As long as you avoid these higher sources of mercury, the benefits of eating fish far outweigh the risks of mercury in fish. Recommendations

The FDA recommends that adults should eat up to 12 ounces per week of a

variety of cooked seafood as long as they avoid the large predatory ocean fish mentioned above and

pay attention to local seafood advisories.

For women who are pregnant or may become pregnant, nursing mothers, and children ages

12 and younger, the following

guidelines apply:

• Eat 8 to 12 ounces (two to three meals) a week of a variety of fish and shellfish that are lower in mercury. Five of the most commonly eaten fish that are low in mercury are shrimp, canned light tuna, salmon, pollock, and catfish.

• Another commonly eaten fish, albacore (“white”) tuna, has more mercury than canned light tuna. So, when choosing your fish, try to select light tuna, and limit albacore to 6 ounces per week.

• Follow these same recommendations

when feeding fish and shellfish to

your young child, but serve smaller

portions.

• Check local advisories about the

safety of fish caught by family and

friends in your local lakes, rivers,

and coastal areas. If no advice is

available, eat up to 6 ounces per

week of fish from local waters, but

don’t consume any other fish during that week. Children under 6 should limit consumption to 1 to 2 ounces

per week, and those 6 to 12 years old should limit intake to 2 to 3 ounces per week.

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that people who ate the most red meat tended to die younger, and the cause of death was more frequently cardio vascular disease or cancer. Further research from the Nurses’ Health Study found that eating one serving per day of nuts, fish, or chicken in place of red meat lowered the risk of heart disease by 30%. The American Institute for Cancer Research recommends eating no more than 12 to 18 ounces of red meat per week, and completely avoid

ing processed meats, such as sausage, ham, bacon, hot dogs, and deli meats. Why is red meat problematic? One factor may be the high saturated fat lev els of many cuts and products. Before buying, check the labels on packaged meats. Look for extra-lean cuts, which contain less than 2 grams of saturated fat per 3.5-ounce portion, and limit your intake of cooked lean meat to no more than 6 ounces in a given day. In addition to its saturated fat con tent, another problem with red meat is

Antibiotics in meat

World attention has increasingly focused on the routine use of

antibiotics in farming—not just to treat animals when they’re ill, but, more often, to increase the rate at which healthy cattle, pigs, and poultry gain weight, so their meat can be brought to market more quickly. This might have seemed like a good idea in the past. But today, there is mounting evidence that this overuse of antibiotics contributes to antibiotic resistance in humans. That’s because the steady use of antibiotics over long periods allows resistant strains of bacteria to emerge, and these new strains can get into the environment and transfer to people.

In 2017, a new FDA rule went into effect prohibiting farmers from treating their animals with antibiotics that are important for human medicine simply to promote the animals’ growth. Now 95% of the medically important antibiotics used in animal feed require veterinary oversight. As a result, the amount of medically important antibiotics used on livestock dropped by a third in 2017. The new law has loopholes, though; it still allows antibiotics for disease prevention at the same dosages as those used for growth promotion.

Antibiotic resistance is a significant public health issue. It can limit your treatment options when you’re sick, raise your health care costs, and increase the number, severity, and duration of some infections. Many doctors warn that some of our tried-and-true antibiotics are losing their ability to fight disease. Many factors contribute to antibiotic resistance, including the use of antibacterial soaps and hand sanitizers and the unnecessary prescribing of antibiotics. However, you can further reduce the growth of antibiotic resistance by choosing antibiotic-free meats (look for “certified organic” or “no antibiotics used” labels) and by consuming more plant proteins.

that cooking it at high temperatures, such as on the grill, promotes the formation of substances called het erocyclic amines, which can contribute to the devel opment of cancer. Meat is also rich in heme iron, a form of iron that the body absorbs more easily than the non-heme iron in plants; but the intake of heme iron has also been associated with increased can cer risk. And emerging evidence links high levels of a dietary metabolite called trimethylamine N-oxide (TMAO)—which the body makes from nutrients found in meat, poultry, fish, dairy, and eggs—with a higher risk of cardiovascular disease and early death, providing another reason to keep animal protein intake to a moderate level.

However, the most worrisome of all meats appear to be processed red meats—a category including bacon, ham, hot dogs, bologna, pastrami, salami, sausage, bratwurst, and pepperoni. In late 2015, an international panel of experts convened by the World Health Organization concluded that processed meat

is a Group 1 carcinogen, meaning that there is now sufficient evidence to state that it raises the risk of can cer—in this case, colon cancer. (By contrast, the panel classified unprocessed red meat as only a Group 2A, or probable, carcinogen.) The hazards of eating pro cessed meat are low compared with those of smoking, for example, but they rise in proportion to the amount of processed meat consumed. The panel defined pro cessed meat as meat that is “transformed through salt ing, curing, fermentation, smoking, or other processes

to enhance flavor or improve preservation.” In addition to the problems with red meat in general, some processed meats also contain added nitrates, which can lead to the formation of cancer causing nitrosamines in the body. Moreover, pro cessed meats tend to have higher concentrations of saturated fat and sodium, which may partly explain why they have been linked with heart disease and related problems. A study published in the journal Circulation analyzed data from 20 studies of diet and

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Dairy products are rich in protein and calcium. But you can also get plenty of calcium from nondairy sources, such as leafy green vegetables, broccoli, beans, and calcium-fortified tofu.

health, including 1.2 million initially healthy partici pants, about 3% of whom went on to develop heart disease, diabetes, or stroke. Results showed that red meat consumption wasn’t associated with heart dis ease or diabetes as long as the meat was unprocessed. However, processed and cured meats, such as bacon, hot dogs, and ham, boosted the risk of heart disease by 42% and diabetes by 19%. Research suggests that even processed white meat, such as turkey and chicken cold cuts and sausage, may be a concern.

If you do eat red meat, make it just an occasional part of your diet. Opt for small portions, choose lean cuts, and avoid charring your meat on the grill. One good option is a lean cut of grass-fed beef. While it is more expensive, grass-fed beef contains less saturated fat than regular beef, and because of the higher nutri

ent value of grass compared with traditional feed, it also contains higher levels of healthful fats, such as omega-3s and conjugated linoleic acid (CLA), which have been linked with lower cancer risk.

The lowdown on dairy

Dairy products, such as milk, cheese, yogurt, and cot tage cheese, are rich in protein and calcium, which is important for keeping your bones healthy.

However, there may be reason to exercise some restraint in your consumption of dairy products. High intake of dairy has been linked with increased risks

of certain cancers. The World Cancer Research Fund Third Expert Report found limited evidence linking higher calcium intake and consumption of dairy foods to increased prostate cancer risk. On the other hand, some research links dairy consumption to lower risk of colorectal cancer. Clearly, more research is needed to understand the relationship of dairy to cancer.

In the meantime, it’s a good idea to limit your

intake of dairy products to two servings per day.

You also can get calcium from regular consumption

of nondairy products, such as leafy green vegetables,

broccoli, beans, and calcium-fortified tofu—though

the amounts available in these foods are often not ©

enough to meet the recommended level of calcium intake without including some dairy, calcium supple ments, or calcium-fortified foods. When you do eat dairy products, choose those that are lower in fat, such as low-fat milk, cottage cheese, and yogurt, instead of high-fat cheese, whole milk, butter, and ice cream. Note that butter has almost no calcium, and ice cream has far less than milk.

Eggs in moderation

Eggs are a good, affordable source of high-quality pro tein, with about 6 grams of protein per large egg. In addition, they are rich in vitamin B12, vitamin D, ribo flavin (vitamin B2), selenium, choline, lutein, and folate.

Eggs were once demonized for their cholesterol. Now, however, they have made something of a come back. According to the Dietary Guidelines, the mod erate amount of cholesterol in eggs doesn’t seem to have a major impact on blood cholesterol levels. More important, some studies have shown that moderate egg consumption (up to one egg per day) does not increase heart disease risk for healthy people.

However, the research is confusing. A recent study found that for every half egg consumed daily, the risk of heart disease rose by 6% and premature death rose by 8%. And nutrients in eggs also contribute to the formation of TMAO (see “What about red meat?” on page 22), which has been linked with cardiovascular disease. For now, it seems best to keep your intake moderate—no more than three eggs per week—espe cially if you are at higher risk for heart disease.

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Vitamins, minerals, and phytochemicals

Every day, your body produces skin, muscle, and

bone. It makes tens of thousands of red blood cells that carry nutrients and oxygen to every cell in your body, and it produces multitudes of white blood cells to fight invaders. Your nerves send electrical signals skipping along thousands of miles of brain and body pathways, and your tissues create chemical messen

gers that shuttle from organ to

organ, issuing the orders that

orchestrate and sustain your life.

To do all that, your body

requires many different raw

materials. In addition to the

macronutrients—carbohydrate,

fat, and protein, which were

covered in earlier chapters—

these include nearly 30 vitamins

and minerals that your body

cannot manufacture in suffi

cient amounts on its own. These

essential compounds perform

thousands of roles in the body:

the lack of a single nutrient leads directly to a spe cific ailment—are rare in the United States, because of our extensive supply of inexpensive food and the fact that many common foods are fortified with cer tain key nutrients. However, getting less than optimal amounts of important vitamins, minerals, and other compounds can still contribute to a number of major illnesses, such as heart disease,

diabetes, cancer, and osteopo

rosis. Hence, concern about

“insufficiency”—a controversial

topic—is a major driving factor

in both the Dietary Guidelines

and the mass marketing of over

the-counter supplements.

So how can you make sure

you’re fulfilling your nutrient

needs? The answer may sound

familiar by now. Eat a well

rounded diet, with plenty of

minimally processed fruits, veg

etables, legumes, whole grains,

they help shore up bones, heal wounds, maintain your immune system, convert food into

Your body requires relatively small amounts of vitamins and minerals. You can get almost everything you need from a plant-based diet.

and lean sources of protein, along with healthy fats, such as nuts and olive oil. In most cases,

energy, synthesize necessary chemicals in the brain, repair cell and tissue damage, and more. The essential vitamins and minerals are often called micronutrients because your body needs only tiny amounts of them. Yet failing to get even those small quantities virtually guarantees disease. British sailors learned centuries ago that living for months without fresh fruits or vegetables—the main sources of vitamin C—caused the bleeding gums and listlessness of scurvy, a disease that often proved fatal. Even today in many low-income countries, people frequently suf fer from a variety of nutrient-deficiency diseases, such as anemia, caused by too little iron.

True vitamin and mineral deficiencies—in which

it’s much better to get your vitamins and minerals from real food than from supplements.

The benefits of food vs. supplements A vast amount of research has shown that you can sig nificantly cut your risk for chronic disease and disabil ity by following a healthy diet, as well as by exercising

regularly and not smoking. While there is also limited evidence that a daily multivitamin-multimineral tab let may be a good general insurance policy against nutrient shortfalls, the evidence for taking high-dose, individual vitamin and mineral supplements for dis ease prevention is much less convincing.

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Supplement manufacturers have not hesitated to exploit positive news from studies about the benefits of vitamins and minerals and to use this information to tout their products. But when put to the test in clin

ical trials, supplements in general have not performed as well as real food—that is, minimally processed or whole foods. For example, broad population studies suggest that people who eat foods rich in vitamin A and beta carotene (which converts to vitamin A in the body) are less likely to develop many types of can

cer, especially lung cancer. However, when research ers tested beta carotene supplements in smokers, they found that people who took the supplements were more likely to develop lung cancer. Subsequent ran domized clinical trials of predominantly nonsmoking men and women have not replicated this finding, but found that taking supplements presented neither ben

efit nor risk for total or specific types of cancer. One problem with taking supplements of the fat soluble vitamins (A, D, E, and K) is that they aren’t readily passed through the body—unlike the water soluble vitamins (C and the Bs), which are generally excreted in urine if they’re not needed (unless taken in exceedingly high doses). By contrast, the fat-soluble vitamins are stored in fat and can build up to toxic lev els if you take too much. By contrast, it’s hard to get too much from food in its natural form. For one thing, the levels in food are lower than in supplements. For another, in the special case of beta carotene, the body slows down the conversion of this substance to vita min A when it has enough, making it hard to overdose. While it’s more difficult to consume dangerous levels of water-soluble vitamins, it’s not impossible. Many nutrition bars contain 100% of the RDA for folic acid. Because many other foods are also enriched with folic acid, it’s not hard to exceed the safe upper limit of daily intake for this nutrient if you take a multivitamin and eat fortified products on a regular basis. And con trary to the claims of some so-called experts, mega doses do nothing to enhance any bodily functions. It can also be easy to overload on minerals like cal cium, which are added to a broad range of products. The body can only absorb 500 mg of calcium at a time. Total intake beyond 2,500 mg a day (or, after age 50, 2,000 mg/day) may damage kidneys and blood vessels.

Does your diet deliver the

recommended dose?

Assuming you rely on food rather than supplements to supply your vitamins and minerals, that raises another question: does your diet deliver enough?

There are two ways to approach this question. The more laborious method is to total up what’s in your diet. If you choose that route, there are free online tools and calculators that can help you analyze the nutrient content of your meals, such as MyFitness

Pal (www.myfitnesspal.com) or Canada’s eaTracker (www.eatracker.ca). You can also research the nutri ent content of various foods using the USDA’s newly revamped FoodData Central website (https://fdc.nal. usda.gov). Or you can consult a registered dietitian, who can access computer programs and databases to help with the most difficult calculations.

Alternatively, you can take a more relaxed approach—that is, not worrying too much about the details and focusing instead on the big picture: eating a balanced diet that contains a variety of colorful fruits and vegetables, whole grains, beans, nuts, dairy prod

ucts, seafood, lean meats, and poultry. When choosing what to eat, simply emphasize nutrient-dense foods, which are packed with vitamins and minerals and have relatively few calories. If your dietary pattern is healthful and mirrors these guidelines, then you don’t have much to worry about.

Shortfall nutrients

While a balanced diet should meet most of your needs, you may have to work a little harder to get enough of several essential nutrients. Nutrition scientists call these the “shortfall nutrients,” because people often fall short of them. According to the Dietary Guide

lines, these three (plus fiber; see page 11) require spe cial attention.

Potassium promotes blood pressure control. Since almost everyone exceeds recommended limits on sodium (which raises blood pressure in salt-sen sitive people), potassium’s role in countering harmful effects of excess sodium is especially valuable. Potas sium may protect the heart and bones in other ways, too. The recommended intake for women 19 and older

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(excluding those who are pregnant or breastfeeding) is 2,600 mg per day, and for men 19 and older, it is 3,400 mg per day—yet the average American gets only 1,997 mg per day. You can boost intake by eating more fruits, vegetables, and beans. Bananas and citrus are well known for being rich in potassium; other all-stars include avocado, kiwi, and melon.

Calcium is essential for bones and seems to help lower risk of colon cancer. Fewer than 50% of Ameri cans meet the Daily Value of 1,000 mg through their diets—but the risk of supplementation is that it can supply too much. Rather than relying on pills, boost your intake by including dairy or calcium-fortified nondairy milk and yogurt twice a day. Dark green leafy vegetables are good sources of calcium (though they contain less than dairy). The body absorbs more from kale, bok choy, and broccoli than from spinach, because the oxalate in spinach binds much of its calcium.

Vitamin D helps your body absorb calcium, mak ing this vitamin essential for bone health. In addition, newer research suggests that it may help protect against cancer and other chronic diseases. Unlike other vita mins and minerals, however, D is not abundant in food sources other than fortified dairy and fatty fish such as salmon, sardines, mackerel, rainbow trout, and tuna. Hence, you may need supplements in order to meet current recommendations for 600 IU per day up to age 69 and 800 IU for age 70 or older. Five to 10 minutes a day of unprotected sun exposure on the hands, arms, and legs can also help, since ultraviolet light striking the skin prompts the body to produce vitamin D.

The power of phytochemicals In addition to vitamins and minerals, a healthful diet will deliver substantial amounts of compounds known as phytochemicals (literally, “plant chemicals”). Even the most humble fruits and vegetables are replete with these compounds, which affect the flavor, color, scent, and other properties of plant-based foods. The sear ing bite of hot peppers, the pungent whiff of garlic, the deep orange hue of carrots, and the red blush of toma toes all owe a tip of the hat to various phytochemicals.

Although plants develop these compounds for their own purposes, including defense against preda

tors, many of these substances appear to be benefi cial for people, too. The results of certain studies on phytochemicals are now well known—the lutein in dark leafy greens may help protect against specific eye ailments; the lycopene in tomatoes may help defend against prostate disease; the proanthocyanidins in cranberries may help ward off urinary tract infections; the anthocyanins in blueberries may help preserve brain health as you age. Many phytochemicals also have anti-inflammatory and antioxidant activities, which are linked to their wide range of benefits, from reducing the risk of Alzheimer’s disease to helping to prevent osteoporosis.

There are thousands of phytochemicals in your fruits and vegetables, and in many cases, they work in networks, so taking a few in supplement form is not the best choice. Instead—you guessed it—try to get them from your food.

While you’re at it, try to broaden the repertoire of fruits and vegetables you eat, so that it includes produce of many colors. Consuming a wide variety of colorful produce—red, yellow, orange, green, purple—ensures that you also get a broad range of phytochemicals in your diet. That’s important because different phyto

chemicals serve different functions in the body. For example, the sulforaphane that comes from cruciferous vegetables (broccoli, Brussels sprouts, cabbage, cauli flower, and others) helps fight cancer by mopping up certain cancer-promoting substances that form in your body during the course of normal metabolism. But you won’t find sulforaphane in your blueberries, even though the anthocyanins—the compounds that give blueberries their deep purplish-blue color—are steeped in antioxidant activity. That’s why you need the variety.

Note that, as a general rule, the darker the fruit or vegetable, the higher the level of phytochemicals you’ll find in it, since many of these beneficial compounds are plant pigments. Thus, a juicy ripe strawberry that’s red straight through will have higher levels of antho

cyanins than one that’s mainly white inside. Despite the importance of color in produce, cer tain white vegetables, such as onions and cauliflower, also contain important phytochemicals. For example, the allyl sulfides in onions, garlic, and leeks have been linked with cancer protection.

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Making healthy beverage choices

Liquids are an essential part of a healthy diet. But

which are best? Today there is a large array of bev

erages to tempt you, including sodas, sports drinks,

energy drinks, bottled teas, vitamin waters, and fruit

drinks. The beverages you choose can have a huge

impact on your health, so it’s worth learning to sort

the healthful ones from the not-so-healthful.

Water on tap

You can’t survive without water. Among its many

functions, it helps aid digestion, prevent constipation, normalize blood pressure, and stabilize your heart beat. Water also carries nutrients and oxygen to cells, cushions joints, protects organs and tissues, helps regulate body temperature, and maintains electrolyte (sodium) balance.

In addition, drinking two glasses 30 minutes before eating may help you lose weight. A similar strategy is simply to drink water between meals. If you wait until you’re thirsty to drink, it’s easy to mistake thirst for hunger and end up eating food when all you really needed was a tall, cool glass of water.

All beverages contain water, but water itself— because it’s naturally calorie-free—is an excellent choice. If plain water seems too boring, you can make it more interesting by drinking sparkling water, or adding citrus or cucumber wedges, or infusing it with herbs, such as basil, lavender, or mint.

Sports drinks and energy drinks

If you work out, do you need special drinks to fuel your

performance? For the most part, no. Most experts agree that water is the perfect hydration beverage for a typical workout. In particular, beware of energy drinks, which can contain a lot of sugar and caffeine. Serious endurance athletes, however, may benefit from the extra calories and electrolytes found in sports drinks.

All beverages contain water, but water itself—because it’s naturally calorie-free—is ideal. If plain water is too boring, try adding citrus or cucumber wedges or infusing it with herbs, such as mint or basil.

A variety of vitamin, sports, infused, and perfor mance waters—which may have small amounts of micronutrients added to them—are widely available. While they may help you meet your daily target for water, it’s best not to rely on them to meet your quota for anything else, as the added levels of micronutri ents are often too low to make an impact on your diet. You’re better off with a balanced diet that provides whole-food sources of these micronutrients.

Coffee and tea

After water, your second best choice is unsweetened coffee or tea. Both are derived from plants and are packed with antioxidant and anti-inflammatory com pounds. They both contain caffeine, which boosts alertness and performance. And they offer a delicious, flavorful choice of beverage, without fat and sugar (as

long as you’re not stirring these into the mix). Coffee. Once frowned upon by health profession als, coffee has experienced something of a renaissance for its numerous health rewards. Originally from Ethiopia, coffee is a brew made from roasted, ground coffee beans that has been enjoyed around the world

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for hundreds of years. A growing body of research finds many health benefits related to coffee intake; it has been linked to better mental and athletic perfor mance and lower risk of diabetes, liver disease, heart disease, Parkinson’s disease, colon cancer, and prema ture death. A recent study, which analyzed data from a half-million people, found reduced risk of prema ture death among coffee drinkers who drank 1 to 8 cups per day. The benefits of consuming coffee may be related to a range of compounds found in coffee beans beyond caffeine, including chlorogenic acid, lignans, quinides, trigonelline, and magnesium, which may help reduce insulin resistance, quell inflammation,

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

Pouring a healthy cup

Even though coffee and tea are healthful—and have zero calories if you drink them plain—both can be a source of significant calories if you don’t. At coffee shops, many people order large coffee drinks laden with milk and sugar that can equal the caloric con

tent of an entire meal. Even a modest tall (12-ounce) cafe latte made with skim milk adds 100 calories to your daily total. With today’s specialty coffee drinks, it’s easy to load up on unhealthy fat, sugar, and calories without eating a bite of food. And since liquid calories are less filling than solid food, drinking sweet drinks increases the chance that you will consume excess calories. Studies also show that consuming too many sugary foods and beverages can increase your risk of heart disease and diabetes.

As for tea, the selection of bottled tea beverages has expanded dramatically in recent years. They may seem like healthy choices, but think again. Many con

tain as much added sugar (and therefore, calories) as soda, and they may not have as much real tea in them as brewed tea. Studies have shown that bottled teas often contain significantly lower levels of the healthful compounds than a cup you brew yourself.

Finally, keep in mind that in some individuals, excessive caffeine can pose problems such as insom nia, esophageal reflux, and migraines. If these are an issue for you, limit caffeine consumption. One way to do this is by drinking no coffee or tea after a certain hour—say, 3 p.m. Another is by switching to decaf later in the day.

Drinks to limit or avoid

Studies increasingly link sugary beverage intake to obesity, diabetes, and heart disease. With the recent attention on the health impact of sweetened beverages and soft drinks, intake in the United States is declin

ing and has already fallen from 53 gallons per person per year in 2000 to 39.25 in 2017. However, sweetened beverages are still a leading source of added sugars in the standard American diet. For example, a can of soda provides about 35 grams (9 teaspoons) of refined sugar. And when you drink your calories, you don’t gain the same sense of satiety as you do from eating solid food, so it’s easy to keep piling on additional cal ories above and beyond those in the drink.

Even artificially sweetened sodas may pose a problem. Although they are very low in calories, some studies have found that they do not necessarily help people lose weight. Some scientists believe that a disconnect between the body and the brain may occur when you guzzle these artificially sweet drinks. The brain thinks energy is going to come along with that sweet-tasting drink, and when no source enters the bloodstream, it may increase feelings of hunger. Intriguing preliminary research also indicates that artificial sweeteners may interfere with gut bacteria in a way that promotes metabolic disorders. While we certainly need more research to understand the full effect that artificial sweeteners have on the body, one thing is certain: there are no nutritional benefits from consuming these beverages, which are often filled with other artificial ingredients.

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Juice drinks. There’s obviously no comparison between soda and fresh-squeezed orange juice. But scientists include juice drinks along with soda as bev erages that people should avoid or drink only occa sionally. In fact, the American Academy of Pediatrics recommends no fruit juice for children under 1 year of age, no more than 4 ounces per day for children ages 1 to 3, no more than 4 to 6 ounces for children ages 4 to 6, and no more than 8 ounces for anyone age 7 or older. Many “fruit drinks” are laced with added sugars. Even apple juice, which serves as the basis for many juice drinks, contains a lot of quick-digesting sugars and not much more. If you really enjoy a glass of orange juice every morning, it’s all right to include a single 4-ounce serving every day. Just make sure that it’s 100% fruit juice. And remember that it takes several oranges to make a single glass of orange juice, so you’re getting more sugar than if you ate the natural fruit. Processing also removes much, if not all, of the fiber-rich pulp.

What about alcohol?

Some sources may proclaim red wine a health tonic, but the science is not as clear-cut as it once seemed. On the positive side, moderate consumption of alcohol in general—not just red wine—has been linked with heart-health benefits. More than 100 studies have found a link between moderate drink ing (no more than one serving per day for women; no more than two for men) and a decreased risk of heart attacks, peripheral vascular disease, strokes, and sud

The science on alcohol consumption is not as clear as it once seemed. While moderate drinking may benefit the heart and reduce diabetes risk, new research has linked it with many forms of cancer.

den cardiac death. Moderate drinking has also been linked to lower incidence of diabetes. And it is part of the healthful Mediterranean diet.

However, the bottle also holds risks. Heavy drink ing can result in a range of health problems, includ ing liver disease and heart disease. A 2018 analysis published in The Lancet found that while there was some protective effect with light drinking (less than one drink a day), “the safest level of drinking is none.” Other studies have found that even moderate alcohol consumption raises the risk of cancer, including of the head and neck, esophagus, liver, breast, and colon. The newly released Third Expert Report from the World Cancer Research Fund recommends not drinking alcohol at all in order to reduce cancer risks.

So, what should you do? If you’re already drink ing, do so in moderation. If you don’t drink, don’t start in order to gain supposed health benefits. And if you’re at high risk for cancer or alcoholism, consider avoiding alcohol entirely.

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Putting it all together

Now that you’ve got a better understanding of what

goes into a healthy diet, it’s time to take the plunge. But how do you get started? Knowing the best sources of fat, carbohydrates, and protein is one thing. Figur ing out how to pack your diet with these healthful foods is another. The reality is that we all tend to eat foods that are familiar. So how do you break those habits and start improving your diet? The greatest challenge for most people is incorporating enough vegetables and—

to a lesser extent—fruits. This chapter includes ways to boost your intake of produce in delicious ways. We also include tips for meal planning, healthful shopping, and doing everything you can to ensure food safety.

Meal planning

If you come home from work to an empty refrigerator, you’re not likely to cook a healthful meal. It takes a bit of organization and planning to stay on top of healthy eating. Following are some tips to help you out.

• Plan your meals for the week, even if it’s just a rough outline. Rely on a mixture of easy go-to dishes you can prepare without a recipe (see page 32), alternat ing with one or maybe two new recipes a week on less busy days to make things more exciting.

• Jot down a shopping list, making sure to include the fresh items you’ll need, as well as pantry staples you may be low on (see “A healthful shopping basket,” page 34).

• Plan your weekly shopping trips for times when you are least stressed and not hungry, so you can make wise food decisions.

• Make sure you always have on hand enough staple

ingredients—such as frozen vegetables, canned

beans, whole grains, eggs, and whole-grain pasta—

to create a healthful meal any day of the week.

• When purchasing perishable foods, buy only those ©

you need for the week, so you won’t waste food or money or feel obliged to overeat.

• Read food labels, avoiding products with excess sodium, added sugars, and saturated fat.

• Prep your meals the night before as needed—put frozen fish in the refrigerator to thaw, soak beans and cook them, and even chop vegetables for your menu the next day.

• Prepare foods with healthful cooking techniques: sauté (in moderate amounts of healthful vegetable oils), roast, bake, poach, or simmer instead of deep fat frying.

• Consider keeping a food journal, which may help you be more accountable for and successful with your health goals, according to several studies.

Sneaking in more vegetables The vegetable world is filled with a dazzling array of colorful leaves, stems, shoots, bulbs, and roots, all offering delicious, nutritious fare. Once humans feasted on mounds of a diverse range of vegetables, but now our consumption is low. Only 9% of Ameri cans meet their recommended level of vegetable intake. And most Americans eat a limited variety of vegetables, relying heavily on potatoes, followed by tomatoes, onions, lettuce, and corn.

The greatest dietary challenge for most people is figuring out how to incorporate enough vegetables. Grilling is a great way to let the deep, rich flavors of vegetables shine through.

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Easy go-to dishes you can prepare without a recipe Easy, healthful meals are within your reach. Just follow these simple ideas for creating meals with supplies you should have on hand in your pantry and refrigerator.
MEAL	INGREDIENTS	DIRECTIONS
Tofu-vegetable stir-fry with whole grains	Whole grain: brown rice, quinoa, or barley Protein: diced tofu Vegetables: onions, bell peppers, snow peas, others Seasonings: peanut oil, reduced-sodium soy sauce	Simmer grain. Stir-fry vegetables in peanut oil, add tofu and soy sauce, and cook until tender.
Whole-grain pasta with greens and poultry	Whole grain: whole-wheat fettuccine, penne, or rotini Protein: cooked chicken or turkey Vegetables: greens (e.g., spinach, kale, chard), tomatoes Seasonings: olive oil, garlic	Boil pasta. Chop rest of ingredients. When pasta is done, drain and return to stove. Add olive oil, garlic, greens, tomatoes, and chicken or turkey. Heat for 5 minutes.
Bean-corn chili with green salad and whole grain bread	Whole grain: whole-grain bread Protein: canned beans (e.g., black, kidney, pinto; no salt added) Vegetables: canned tomatoes (no salt added), frozen corn, onions, bell peppers, others; bagged lettuce mix Seasonings: garlic, chili powder, olive oil, lemon juice	Mix beans, tomatoes, chopped onions, chopped bell peppers, frozen corn, garlic, and chili powder in a pot. Simmer for 30 minutes. Separately, toss lettuce with olive oil and lemon juice. Serve with whole-grain bread.
Mediterranean fish fillet with sautéed vegetables and grain	Whole grain: farro, brown rice, or millet Protein: fish fillet (e.g., salmon, cod, or halibut) Vegetables: kale, broccoli, cauliflower, green beans, others Seasonings: olive oil, garlic, sun-dried tomatoes, olives, pine nuts	Simmer grain. Sauté vegetables in a skillet until tender. Cover to keep warm. Sauté fish fillet with olive oil and garlic until opaque throughout. Serve cooked fish with grain and vegetables. Garnish with sun-dried tomatoes, olives, and pine nuts.
Buddha bowl with whole grain, vegetables, plant protein, and flavorful sauce	Whole grain: brown rice, quinoa, or sorghum (cooked, chilled) Protein: canned beans, baked tofu, pumpkin seeds, or seasoned tempeh Vegetables: fresh asparagus, broccoli, kale, cucumbers, tomatoes, bell peppers, others Seasonings: tahini, reduced-sodium tamari, or olive oil vinaigrette	Put cooked whole grain in a bowl. Chop vegetables and arrange over grains. Arrange beans (or other plant protein) over vegetables. Drizzle with sauce or dressing.
Moroccan-style baking sheet meal with roasted vegetables, brown rice, and beans	Whole grain: Cooked brown rice Protein: canned (no salt added) or cooked chickpeas, black beans, or white beans Vegetables: onions, mushrooms, sweet potatoes, squash, zucchini, others Seasonings: olive oil, turmeric, cumin, and garlic	Slice vegetables and spread on a baking sheet with brown rice and chickpeas or beans. Drizzle with olive oil and toss with tongs. Sprinkle with spices. Roast on top shelf of oven at 400° F until golden brown, stirring after 15 minutes.

This needn’t be the case. There are many ways to boost your vegetable intake to recommended levels (see Table 6, page 33), and you can do it without spend ing hours in the kitchen, chopping, slicing, and dicing. Many supermarkets now have salad bars, which include offerings like kale salads or roasted red peppers. You can often find precut vegetables in the produce section. Or you can buy frozen chopped vegetables.

You can incorporate vegetables into almost any meal. Here’s how.

Don’t be afraid to start your day with vegeta bles. Some cultures enjoy vegetables at breakfast. Try radishes on toast, baked tomato halves with eggs, and fajita vegetables with a breakfast burrito.

Try interesting ways of preparing vegetables. Use a spiralizer to make “noodles” out of zucchini

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or squash. Use a vegetable peeler to create ribbons of cucumbers, asparagus, and carrots to add to salads. Begin a meal with soup. Vegetable-rich soups— such as carrot-ginger, tomato-fennel, or gazpacho— are an excellent way to pack a couple of servings of vegetables into your meal.

Turn vegetables into healthful snacks. For example, bell peppers, carrots, and celery can be deli cious dipped in hummus or unsweetened yogurt, or spread with peanut butter or sunflower-seed butter.

Have a salad with dinner. Stock your salad with dark green leafy lettuce and toss in petite peas, toma toes, onions, celery, carrots, broccoli, and peppers. Bonus: In addition to the nutrient bonanza you’ll get, studies show that starting meals with a low-calorie salad can help you consume fewer calories at the meal, as long as the salad is no more than 100 calories. To help control calories, avoid creamy dressings. A simple dressing you can make yourself is half olive oil and half vinegar or lemon juice, seasoned to taste with herbs and pepper.

Cook vegetables the delicious Mediterranean way. Place any type of fresh vegetables—carrots, greens, broccoli, or cauliflower—in a skillet or sauté pan with a drizzle of olive oil and water. Season as desired and sauté only until crisp-tender.

Roast vegetables along with whatever entree is in the oven. Roasting is a great way to let the deep, rich flavors of vegetables shine through because their starches start to convert to sugar at around 375° F, releasing a nutty sweetness. To roast, just bake cut-up vegetables with a drizzle of healthy oil at 375° F for 20 to 25 minutes or until they’re lightly browned. Any vegetable is a roasting candidate—from mushrooms, onions, eggplant, and zucchini to tomatoes, broccoli, and carrots—so don’t limit yourself. Enjoy roasted vegetables as a side dish or toss them into pasta dishes and other recipes.

Poach vegetables in low-sodium broth and white wine. Add garlic, basil, thyme, oregano, or tar ragon for a flavor bonus. To poach, boil enough liquid to cover the vegetables. When it boils, add the vege tables. Turn down the heat to just below boiling and cook the vegetables for about five to seven minutes, until they’re brightly colored and tender-crisp. To

retain nutrients, keep a watchful eye on the pot or set a timer so you don’t overcook.

Add fresh cut vegetables to main dishes. Try adding mushrooms, peppers, zucchini, onions, or car rots into pasta sauce, casseroles, soup, stews, scram bled eggs, and chili.

Smuggle pureed vegetables into recipes. A Penn State study found that covertly adding pureed vegetables to classic foods like a casserole, macaroni and cheese, or carrot bread reduced calorie intake and boosted vegetable consumption. Pureed cooked veg

etables can easily be used as sauces, soups, spreads, and toppings.

Reaping nature’s sweet reward: Fruits Unfortunately, we’re not doing so great on the fruit front either. The recommended intake is 1½ to 2 cups per day (see Table 6, below), but only 12% of Ameri cans eat that much, according to the CDC. One of the reasons people fall short on fruit intake is that they opt instead for processed snacks, treats, and desserts, thus crowding out fruit.

Fruit is nature’s most perfect dessert. Rich in nat ural sugars, it is truly the first sweet treat our early

Table 6: Vegetables and fruits: How much is enough? If you think eating “five a day” of fruits and vegetables is enough, think again. The USDA now recommends 2½ to 3 cups of vegetables per day (roughly five to six half-cup servings) in addition to 1½ to 2 cups of fruit (roughly three to four half-cup servings). That’s eight to 10 servings of produce a day. It seems like a lot, but fruit and vegetable consumption is linked with so many benefits, including weight control and lower risk of chronic diseases.
AGE	VEGETABLES PER DAY	FRUIT PER DAY
Women
19–30	2½ cups	2 cups
31–50	2½ cups	1½ cups
51+	2 cups	1½ cups
Men
19–30	3 cups	2 cups
31–50	3 cups	2 cups
51+	2½ cups	2 cups
Source: USDA MyPlate.

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A HEALTHFUL SHOPPING BASKET

Make copies of this shopping list to take on your supermarket runs. You won’t buy everything on this list each time you shop, but it will help remind you of healthy categories. Check off the items you need before you go.

Grains

❑ Whole grains

(e.g., quinoa, spelt)

❑ Brown rice

❑ Bulgur/cracked wheat ❑ Oatmeal, old-fashioned or steel-cut

❑ Popcorn, light

❑ Whole-grain breads, pitas, tortillas

❑ Whole-grain cereal ❑ Whole-grain pasta

Legumes, nuts, and seeds ❑ Almonds

❑ Black beans

❑ Chickpeas (garbanzos) ❑ Kidney beans

❑ Lentils

❑ Peanut butter

❑ Peanuts

❑ Pine nuts

❑ Pinto beans

❑ Pistachios

❑ Pumpkin seeds

❑ Sesame seeds

❑ Soybeans/edamame ❑ Sunflower seeds

❑ Tofu

❑ Walnuts

Vegetables

❑ Asparagus

❑ Avocado

❑ Beets

❑ Bell peppers (green, red, orange, yellow) ❑ Broccoli

❑ Brussels sprouts ❑ Cabbage (green, red) ❑ Carrots

❑ Cauliflower

❑ Corn, sweet yellow ❑ Green beans

❑ Garlic

❑ Kale

❑ Lettuce/greens

❑ Mushrooms

❑ Onions (green, red, white, yellow)

❑ Peas

❑ Radishes

❑ Squash

(summer, winter)

❑ Spinach

❑ Sweet potatoes ❑ Swiss chard

❑ Tomatoes

Fruits

❑ Apples

❑ Apricots

❑ Bananas

❑ Blueberries

❑ Cantaloupe

❑ Cherries

❑ Cranberries

❑ Grapefruit

❑ Grapes

❑ Kiwifruit

❑ Mangoes

❑ Oranges

❑ Peaches

❑ Pears

❑ Pineapples

❑ Plums

❑ Prunes (dried plums) ❑ Raisins

❑ Raspberries

❑ Strawberries

❑ Watermelon

Oils

❑ Canola oil

❑ Olive oil

❑ Safflower or

sunflower oil

Dairy and dairy

alternatives

❑ Cheese, reduced-fat ❑ Cottage cheese, low-fat ❑ Eggs

❑ Milk, low-fat or fat-free ❑ Plant-based milk (e.g. soy milk, almond milk) ❑ Yogurt, low-fat or fat-free

Fish and shellfish

❑ Cod

❑ Flounder

❑ Halibut

❑ Salmon

❑ Scallops

❑ Shrimp

❑ Sardines, canned in olive oil or water

❑ Tuna, light, canned in water or olive oil

Poultry

❑ Skinless chicken breast/ thigh

❑ Skinless ground chicken or turkey breast

❑ Skinless turkey breast/ thigh

ancestors experienced (other than the occasional bit of honeycomb). But unlike processed sweets, which are largely devoid of nutrients, fruit comes packed with a vibrant array of healthful nutrients, including slow-digesting carbs, fiber, vitamins, minerals, and phytochemicals—all in a very low-calorie package. A serving of fruit (one small piece, or half a cup) con tains about 60 calories, on average. Eating fruit on a regular basis is a very healthy habit and is linked with myriad benefits, including a lower risk of high blood pressure, heart disease, stroke, certain types of cancer,

degenerative eye disease, diabetes, obesity, Alzheim er’s disease, and diverticulitis.

Some fruits have particular benefits. For example, berries may help protect the brain from age-related decline, according the Nurses’ Health Study, which found that greater intake of blueberries and strawber

ries was linked with preserved brain function. In fact, research shows that eating more fruits (as well as veg etables) can improve psychological well-being. And citrus fruit has been found to have cancer-fighting potential, according to growing research. So it’s a good

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idea to enjoy a variety of colorful, seasonal fruits every single day.

Here are some ideas to help

you boost your fruit consumption

throughout the day:

• At breakfast, include fruit, such ©

as sliced strawberries over cereal, peach chunks stirred into yogurt, or applesauce over whole-grain pancakes.

A number of studies have correlated a higher intake of blueberries and strawberries with better brain function over time.

health of waterways, soil, air, wildlife, farm workers, and the climate. The evidence that organic foods are also healthier for people is not as strong, but it’s growing. Recent stud ies have noted higher levels of vitamin C, phytochemicals, and antioxidant activity in organic produce. In addi tion, researchers have documented lower pesticide residues in people

• For breakfast or lunch, whip up smoothies with fro zen berries, mangos, pineapple, or bananas, along with water or milk. (To boost your veggies at the same time, try tossing in some spinach or other greens.)

• Pack a piece of fruit for on-the-go eating at the office, at school, or while commuting. Some of the best choices (which require no special preparation other than peeling or washing) are bananas, apples, pears, oranges, and nectarines.

• Keep a bag of dried fruit—such as raisins, dried ber ries, and dried apples—in your purse or briefcase for a quick snack when hunger hits. But remember, a quarter-cup is the portion size for dried fruit, so keep portions small. And look for versions without added sugars.

• When making a stir-fry, try adding some frozen unsweetened mango or canned pineapple (without the juice).

who eat organic foods. This has potential health impli cations. A highly publicized study, published in JAMA Internal Medicine in 2018, followed nearly 70,000 French adults and found that those with the highest consumption of organic foods had a 25% reduced risk of cancer over the seven years of the study. However, such a study doesn’t prove cause and effect, and there were some shortcomings inherent in the methodology, so more research is needed.

One drawback for many people is that organic foods come at a higher price. If you’re interested in organic production, focus your food dollars where it matters the most—by avoiding the types of fresh pro

duce most likely to retain pesticide residue. The Envi ronmental Working Group publishes a list called the Dirty Dozen that names the fruits and vegetables with the highest levels of pesticide residue when grown conventionally. These are the most important ones to buy organically, if your grocery budget allows:

• Make fruit your go-to dessert. Enjoy the simple, sweet flavor of fruit at the end of each meal to sat isfy that sweet tooth. For special occasions, you can indulge in fruit-based desserts, such as apple crum bles, strawberry shortcake, cherry bars, or plum

1. strawberries 2. spinach

3. kale

4. nectarines 5. apples

6. grapes

7. peaches 8. cherries 9. pears

10. tomatoes

11. celery

12. potatoes

13. hot peppers (an extra

item in 2019).

tarts.

Are organics worth it?

The Environmental Working Group also publishes a list called the Clean Fifteen, which names the foods that have the lowest levels of residues and are there fore fine to buy in conventional form:

Organic foods continue to grow in popularity. Organic sales broke through the $50 billion mark in 2018 for the first time, according to the Organic Trade Associa tion. Organic foods are clearly healthier for the planet, because they support an agricultural system that avoids synthetic fertilizers and pesticides and promotes

1. avocados 2. sweet corn 3. pineapples 4. sweet peas, frozen

5. onions

6. papayas

7. eggplants 8. asparagus 9. kiwis

10. cabbages 11. cauliflower

12. cantaloupes 13. broccoli 14. mushrooms 15. honeydew melons.

a more biodiverse ecosystem, with attention to the

If you can, it’s also good to buy meat and dairy

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Table 7: Culinary uses of common herbs and spices Don’t hesitate to experiment with herbs and spices to boost the flavor and health of your meals, not to mention the pleasure you can derive from the bounty of scents and colors they provide. A combination of herbs and spices in meals provides even greater flavor and health rewards. Use this guide to help inspire you.
SPICE OR HERB	CULINARY USES
Allspice	Use in breads, desserts, and cereals; pairs well with savory dishes, such as soups, sauces, grains, and vegetables.
Basil	Slice into salads, appetizers, and side dishes; enjoy in pesto over pasta and in sandwiches.
Cardamom	Good in breads and baked goods, and in Indian dishes, such as curry.
Cilantro	Use to season Mexican, Southwestern, Thai, and Indian foods.
Cinnamon	Stir into fruit compotes, baked desserts, and breads, as well as Middle Eastern savory dishes.
Cloves	Good in baked goods and breads, but also pairs with vegetable and bean dishes.
Cumin	Accents Mexican, Indian, and Middle Eastern dishes, as well as stews and chili.
Dill weed	Include in potato dishes, salads, appetizers, and dips.
Garlic	Add to soups, pastas, marinades, dressings, grains, and vegetables.
Ginger	Great in Asian and Indian sauces, stews, and stir fries, as well as beverages and baked goods.
Marjoram	Add to stews, soups, potatoes, beans, grains, salads, and sauces.
Mint	Flavors savory dishes, beverages, salads, marinades, and fruits.
Nutmeg	Stir into fruits, baked goods, and vegetable dishes.
Oregano	Delicious in Italian and Mediterranean dishes; it suits tomato, pasta, grain dishes, and salads.
Parsley	Enjoy in soups, pasta dishes, salads, and sauces.
Pepper (black, white, red)	Seasons soups, stews, vegetable dishes, grains, pastas, beans, sauces, and salads.
Rosemary	Try it in vegetables, salads, vinaigrettes, and pasta dishes.
Sage	Enhances grains, breads, dressings, soups, and pastas.
Tarragon	Add to sauces, marinades, salads, and bean dishes.
Thyme	Excellent in soups, tomato dishes, salads, and vegetables.
Turmeric	Essential in Indian foods; pairs well with soups, beans, and vegetables.

organically, since no antibiotics or added hormones are used. But the most important step you can take toward a healthier diet is simply eating more fruits and vegetables, whether they’re organic or not. The health benefits of eating more produce—even if it is conventionally grown—far outweigh the downsides of higher pesticide residues. And while you’re at it, steer clear of organic snack foods. After all, organic junk food, such as chips, cookies, and crackers, is just that—highly processed, low-nutrient junk.

Boosting flavor with herbs and spices Spices and herbs have been treasured for their role in healing, food preservation, and flavor since the begin ning of time. Snippets of herbs (the leaf of a plant, such as parsley or basil) and pinches of spices (any other part of the plant, such as buds, bark, berries, roots, seeds, or stigmas) provide much more than flavor. These plant foods are concentrated sources of phytochemicals with antioxidant and anti-inflam matory properties. The mere act of adding herbs and spices to your salad dressing can boost the level of antioxidant compounds in your salad, as much as doubling it, depending upon the seasonings and the amount you use.

A growing body of evidence suggests that this may translate into health protection. Some spices have par ticular benefits. For example, turmeric—an essential spice in Indian curries—has been investigated for its potential in Alzheimer’s disease protection, and ginger has been shown to be effective for fighting nausea dur ing pregnancy and chemotherapy. Studies have found that spices have synergistic benefits—that is, the com bination of several at once may have additive effects.

Research now suggests that herbs and spices also possess anti-cancer, glucose-lowering, and choles terol-lowering abilities, as well as the potential to influence mood and cognition. Preliminary evidence even suggests that people who eat spicy foods live lon ger. In one study published in the journal BMJ, Har vard researchers looked at data gathered from more than 480,000 people in China over a period of about seven years and found that people who ate food with spices (in particular, chili peppers) every day had a

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Top 10 sources of sodium

More than 40% of the sodium in the average American

diet comes from these 10 types of food, mostly because

of the addition of salt in the preparation and processing of

these foods and dishes.

Adding herbs and spices to food allows you to cut down on sodium without cutting down on flavor. And growing evidence suggests that, like other plant foods, they pack a variety of health benefits.

14% chance of living longer than those who ate spicy foods less than once a week. In addition, those with higher consumption of spicy food were less likely to have died from cancer, heart disease, or respiratory disease during the study period.

1. breads and rolls 2. pizza

3. sandwiches

4. cold cuts and cured meats

5. soups

6. burritos and tacos Source: CDC.

7. savory snacks (chips, popcorn, pretzels, snack mixes, crackers)

8. chicken (fried chicken, prepared entrees)

9. cheese

10. omelets and other egg dishes.

For some ideas on how to liven up your diet with spices and herbs, see Table 7 (page 36).

Trimming salt

Another side benefit of spicing up your diet is that it can help boost flavor and allow you to trim salt in foods. Too much salt in the diet is a bad thing. As sodium accumulates in the bloodstream, the body may hold on to water to dilute it, which increases the fluid in blood vessels and surrounding cells. Over time, this can lead to the stiffening of blood vessels, high blood pressure, heart attack, stroke, and heart failure. A new study in northern China found that nearly 20% of car diovascular disease deaths among adults ages 25 to 59 were attributable to high sodium intake. Too much sodium can also damage kidney function and the ner

vous system.

Sadly, Americans consume way too much sodium— more than 3,400 milligrams (mg) per day on average, most of it from prepared and processed foods (see “Top 10 sources of sodium,” above right). The National Acad emies of Sciences, Engineering, and Medicine recently updated their sodium Dietary Reference Intakes, not ing that for people over age 14, just 1,500 mg of sodium a day is sufficient, and that to reduce risk for chronic disease, you should consume no more than 2,300 mg per day—the amount in about 1 teaspoon of salt.

Try these tips for reducing salt in your diet: Do more of your own cooking. Most of our sodium comes from prepared and processed foods. So,

preparing more of your own foods—soups, entrees, side dishes, sandwiches—from scratch using fresh, whole ingredients can have a sizable impact on your sodium intake. Use more herbs and spices as season

ings, and don’t automatically reach for the saltshaker before tasting foods.

Take it slowly. You get used to a certain level of saltiness and notice right away when a food is miss ing salt. But your taste buds aren’t sensitive enough for you to notice small reductions. By gradually cutting back the amount of salt in your foods, you can retrain yourself to be perfectly happy with less salt.

Be a reader. Scanning the Nutrition Facts on packaged or processed foods can help you make healthier choices. Look for foods that have less than 240 mg of sodium per serving. Since sodium appears in processed food in many forms, simply checking for salt (sodium chloride) in the ingredient list won’t work. You also need to be on the lookout for the word sodium in various combinations—such as sodium benzoate, disodium or monosodium glutamate, and sodium nitrite.

Choose low-salt versions of packaged foods. Many products, including various soups, crackers, and canned vegetables and beans, come in low-salt, reduced-salt, or no-added-salt versions. For nuts, choose unsalted.

Beware of portion distortion. When it comes to packaged food, restaurant food, and even food made at home, the more food you eat, the more sodium you’ll take in. Controlling your portion sizes will

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help you trim your salt intake—and maybe your waist as well.

Take charge when dining out. Restaurant foods are often loaded with sodium. While that’s most obvi ous at fast-food and chain restaurants, it also applies to many so-called white-tablecloth restaurants. Fortu nately, many dining establishments now offer lower sodium choices. If your food is being made to order, don’t hesitate to ask that it be made without salt.

Don’t get sauced. Many traditional gravies and sauces are loaded with salt, as are some salad dress ings. When dining out, ask that sauces be served on the side so you can control the amount. When cook ing at home, try a low-sodium recipe. Home and pro fessional chefs have cooked up low-sodium versions

Food safety

Food-borne illness is a serious matter. The CDC

estimates that every year, one in six Americans, or 48 million people, get sick with vomiting, diarrhea, or worse (such as life-threatening kidney failure)—all as the result of pathogens they consume in food or water. The result is 130,000 hospitalizations and 3,000 deaths annually, with untold numbers of people suffering in silence at home with what they mistakenly call “stomach flu.”

of barbecue sauce, hollandaise sauce, pesto, and more. You can find hundreds of these updated recipes on the Internet, or make up your own.

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

Powering up with probiotics Your large intestine contains 100 trillion “good” bac teria that are essential to your health. They help main tain healthy bowel function, fending off ailments like inflammatory bowel disease and Salmonella and E. coli infections. They may even play a role in regulating weight, liver function, and mood, though more study is needed to confirm those findings.

All people start out with a colony of these benefi

Figure 5: How much should you heat foods?

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

Older people and the very young are especially vulnerable to the effects of contaminated food. The best defense against food-borne illness is to be careful about how you buy, clean, separate, cook, and chill the foods you eat. The USDA recommends these strategies to keep yourself safe from food-borne illness:

165° F (74° C)

160° F (71° C)

Poultry, stuffing,casseroles, reheated leftovers

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

Beef, pork, lamb, veal steaks

• Clean your hands and all food surfaces (counters and chopping boards) with hot soapy water before preparing any food.

• Wash all fruits and vegetables before

preparing or eating

them.

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

shopping, preparing, and storing foods.

• Cook foods to a safe temperature (see

Figure 5, at right) to kill microorganisms.

• Refrigerate perishable foods promptly.

• Defrost frozen foods by thawing in the

refrigerator, in a cold water bath, or in the microwave.

• Avoid raw,

unpasteurized milk.

145° F

(63° C)

140° F

(60° C)

40° F

(4° C)

0° F

(–18° C)

Source: FDA.

and roasts with a 3-minute rest time; seafood*

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

Danger zone

Refrigerator temperatures

Freezer temperatures

* Fish is properly cooked when it flakes easily with a fork.

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cial microorganisms in their gut, courtesy of physi cal contact with their mothers—in the womb, during the birth process, and via breastfeeding. But you take in other beneficial bacteria—known as probiotics— through food. The microbes that turn milk into yogurt and kefir are among the most helpful, but they can be destroyed during processing. When you buy com mercial yogurt and kefir, look for the words “live and active cultures” on the label, to make sure the manu facturer has tested production methods and knows the bacteria can survive.

Fermented foods are another good source, under the right circumstances. Beneficial microbes turn cabbage into sauerkraut, cucumbers into sour pickles, soybeans into miso, and sweetened tea into kombucha. But if the products have been pasteur

ized—as with most fermented foods in packages— the microbes will be dead. In addition, most pickles and sauerkraut are canned and pickled in hot vinegar solutions with high acidity that combines with the heat to kill live, active bacteria. The best solution is to buy from delis where they do the pickling themselves or natural food stores that carry fermented foods. Or make your own; you can find clear and easy instruc

tions in the book The Art of Fermentation by Sandor Ellix Katz (see “Resources,” page 53).

There are also probiotic supplements on the mar ket, of course. But it’s not easy to sift through them and find exactly what you need. Usually the number of bacterial strains in these products is limited to a handful, compared with 3,000 or so in your gut. And as with antioxidants, not all gut bacteria are alike. Dif ferent ones play different roles in the body, so if you’re trying to treat a specific condition, such as irritable bowel syndrome or diarrhea, you need to find the right ones with documented benefits for that condi tion. Ask your health care provider if there’s a product that’s specific to your health needs. For general health, s

look for brands that contain both Lactobacillus and

Bifidobacterium.

Another way to nurture your good gut bacteria

is to eat foods known as prebiotics. These are foods

that the bacteria themselves like to feed on, and they ©

include the fermentable fibers that are found in foods like onions, bananas, leeks, garlic, oats, and soybeans

(see “Fiber,” page 11). Once again, a whole-foods diet appears to be the most healthful—for both you and your gut bacteria.

Restaurant survival strategies Your best bet for meeting your health goals is to cook your own meals at home, where you can control the ingredients and portion sizes. However, we all enjoy eating out from time to time. Just keep in mind that restaurant meals—in particular, fast-food meals—are linked with higher intakes of calories, sugar, saturated fat, and sodium, and lower intakes of healthful foods, such as fruits, vegetables, and whole grains. One of the biggest problems you’ll face when you dine out is sheer portion size, which has increased dramatically over the years. Those bigger portions translate into more calories, sodium, sugar, and saturated fat.

Fortunately, the dining scene has improved. The FDA now requires chain restaurants to provide con sumers with clear and consistent nutrition informa tion on menus, menu boards, and in writing, which can help you make healthier choices. And more and more restaurants are meeting consumers’ desires for healthier fare by providing smaller portions, more fruits and vegetables on the menu, more vegetarian options, and lighter preparation styles.

DINNER MENU

Before going to a restaurant, try checking out the menu online to find the healthiest dishes. Then pick out a healthful selection instead of making an impulse decision that could be less nutritious.

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Table 8: Monster restaurant meals Beware of extremely high levels of calories, saturated fat, sugar, and sodium in restaurant food. The following values are for a single serving.
FOOD TYPE	RESTAURANT AND MENU ITEM	CALORIES	SATURATED FAT	SUGAR	SODIUM
Beverage	Red Robin: Monster Chocolate Milkshake	1,020	24 g	128 g	380 mg
Appetizer	California Pizza Kitchen: Avocado Club Egg Rolls	1,240	21 g	24 g	1,980 mg
Soup	Panera Bread: Vegetarian Creamy Tomato Soup (in a bread bowl)	900	8 g	13 g	1,740 mg
Salad	Applebee’s: Oriental Grilled Chicken Salad	1,310	13 g	47 g	2,140 mg
Entree	The Cheesecake Factory: Lunch Pasta Carbonara with Chicken	1,620	47 g	7 g	2,960 mg
Entree	IHOP: Fisherman’s Platter	1,340	16 g	11 g	3,750 mg
Entree	Sonic: Bacon Double Cheese Double Burger	1,030	23 g	12 g	1,880 mg
Entree	Olive Garden: Tour of Italy	1,520	48 g	19 g	3,250 mg
Entree	TGI Fridays: Chicken Parmesan Pasta	1,800	43 g	22 g	4,060 mg
Dessert	BJ’s: Salted Caramel Pizookie	1,360	29 g	154 g	1,415 mg
Source: Restaurant websites.

Follow these tips for dining out healthfully: • Patronize restaurants where good choices— seafood, whole grains, legumes, fruits, and vegetables—abound.

• Check out the restaurant website in advance in order to decide what you’ll order, instead of mak ing impulse decisions. Many restaurants post their menus online, enabling you to find the healthiest entrees. Some even list nutritional information on menu items. Beware of those with high calorie, fat, sugar, and sodium levels (see Table 8, above).

• Skip pan-fried or deep-fried foods. Instead, look for foods prepared with healthful techniques, such as baking, grilling, poaching, or roasting.

• Avoid dishes prepared with gravy and heavy sauces. Or ask the waiter to use half the sauce or to serve the sauce on the side so you can decide how much of it to use. Because gravy is often made with fatty pan drippings from meat, it’s relatively high in sat

urated fat. Many sauces are made with butter and cream, which are also high in saturated fat. • Resize your portions: split a meal with a friend,

order small plates or side dishes, or take half of it home for lunch the next day. Take advantage of the “small plates” trend, in which you and your dining companions share small servings and avoid large portions of single dishes.

• Get extra vegetables. Many restaurant entrees don’t come with a generous serving of vegetables. But you can easily remedy that by asking for more vege tables, ordering vegetables from the side dish selec tion, or substituting vegetables or a salad for a less healthful side dish, such as fries.

• Lighten up dessert. Skip the indulgent, rich des serts, such as ice cream, cakes, and pastries (some can contain more than 1,000 calories) and go for simple treats, such as berries and peaches. If you want a sweet dessert, share it with others at your table. You’ll get the full taste, but just a fraction of the calories, sugar, and unhealthy fats.

• Watch those beverages. Sweetened drinks (often refilled during the meal) and alcoholic beverages can add hundreds of calories to your meal. Opt for sparkling water, plain tea, or coffee.

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Snack food makeover

S nacking is at an all-time high: 80% of American

consumers say they snack at least once per day, according to a 2018 Technomic survey, and consumers are more likely now to replace one or two meals per day with snacks, compared with 2016. That’s not to say that there is anything inherently wrong with snacking. Many people find that their energy flags unless they eat some

thing every four hours or so. In fact, snacking can even

help prevent weight gain, if it staves off the type of rav

enous hunger that often derails the best diet intentions.

The problem isn’t snacking per se. It’s that, rather

than planning ahead to have healthy snacks on hand, ©

people typically grab things like chips, cookies, sweet or salty snack mixes, and chocolate-dipped granola bars from vending machines or checkout counters. Often snacks furnish nothing more than calories in the form of refined grains, sugars, and saturated fat, with a dose of sodium to boot. And more consum

ers are eating mindlessly, in front of TVs, computer screens, tablets, and phones. They are also turning to highly processed snack foods instead of regular meals, squandering an important opportunity to boost the diet with nutrient-rich whole foods.

So how can you get back on track? This chapter will outline some ways.

Smarter snacks

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

When choosing snacks, try to follow the same guidelines you would for a meal, prioritizing whole foods and the healthiest souces of fats, carbohydrates, and protein.

healthful while they may really be full of added sugar and excess calories.

Many people are confused about what makes a healthful snack, but it’s not complicated. When choos ing snacks, simply follow the same guidelines as you do for meals—prioritize whole foods with little pro cessing, and look for the healthiest sources of fats, car bohydrates, and protein (see “Mix and match,” page 42). Here are some suggestions, each one providing roughly 150 to 200 calories:

• 8 ounces plain Greek yogurt with fresh or frozen berries and a sprinkle of granola

• 1 cup garlic-roasted edamame in the pod • 1½ ounces trail mix of dried cherries, dark choco late, and walnuts

• ¼ cup hummus with 1 cup fresh vegetables, such as baby carrots, broccoli florets, and cherry tomatoes • 1 slice whole-grain flatbread with 1 tablespoon

almond butter and 1 teaspoon fruit spread • 1 banana, sliced and spread with 1 tablespoon pea nut butter

• 1 cup cooked oatmeal with a dusting of cinnamon, 1 tablespoon raisins, and ½ cup low-fat milk or soy milk.

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Seven snacking strategies

How can you keep snacking from derailing your healthy eating program, not to mention weight con trol? Try these tips.

Don’t skip meals. Skipping meals may seem like a good way to cut calories, but in fact this just makes you so hungry later in the day that you’re vulnerable to devouring mega-portions of snack food, in order to supply your body with easily digested sugars.

Keep junk food out of the house. There’s a lot of truth to the old joke about the “see-food diet”—if you see food, you eat it. The opposite is also true. If you don’t have junk food lying around, you won’t be tempted by the sight of it, so don’t even bring it home. After all, you can’t eat what isn’t there. Or, if some

one in your household tends to buy chips or other unhealthful snacks, put them out of sight. Don’t eat straight from the bag or carton. If you snack on an open, club-store bag of crackers or a tub of frozen yogurt, chances are you’ll eat more than a single serving. Instead, portion out your serving in a dish or bowl to take better control.

Eat mindfully. Have you ever watched a show on television with a bag of chips or pint of ice cream in hand, only to find that it was all gone before you knew it? This type of mindless eating can pack on a lot of unwanted calories. The solution is simple. Try not to snack while doing something else like surfing the Web, watching TV, or working at your desk. Instead, stop what you’re doing for a few minutes and pay attention to your snack. Savoring a piece of fine chocolate can be more satisfying than mindlessly gobbling down a whole chocolate bar.

Remember, you can take it with you. Think

Mix and match

The most healthful snacks have more than one

macronutrient—protein, fat, carbohydrates. Try a

handful of whole-grain crackers (carbohydrate) with some low-fat cheese (protein, fat) or tofu (protein); a small amount of dried fruits (carbohydrate) with nuts (protein, fat); or plain popcorn (carbohydrate) sprinkled with low fat cheese (protein, fat). The mix of macronutrients is more satiating than straight carbohydrates.

The most healthful snacks combine macronutrients—for example, ©

mixing nuts (protein and fat) with dried fruits (carbohydrates). The protein and fat slow down the digestion of the carbs.

ahead, and carry a small bag of healthful snacks in your purse or the glove compartment of your car. If you have a healthy snack handy—preferably, one you really like—you won’t turn in desperation to the cal

orie-laden cookies at the coffee counter or the candy bars in the office vending machine.

Zero in on hunger. Before you snack, ask yourself, “Am I truly hungry?” Many of us mistake emotions, such as stress and fatigue, for hunger. If the answer is yes (your stomach feels hollow), make sure you’re not confusing hunger with thirst. Drink an 8-ounce glass of water; then wait 10 to 15 minutes. If you’re still hungry, have a healthful snack.

Know your cravings. If you want a snack but you’re not hungry, attack cravings from a psycho logical level. Ask yourself how you’re feeling. Lonely? Bored? Stressed? Then, ask yourself the bigger ques tion: will food fix this problem? The answer is always no. Eating a cookie, for example, won’t address a prob lem at work that you’re worried about. Go for a walk around the block, do a few stretches, put on some music, or choose another simple activity that might distract you or boost your mood. Then if you still want the food, fine. Ask yourself what food you really want. Then eat only a small amount, and make it good. If you’re craving chocolate, for example, eat one small square and savor it. It’s important that you snack on what you’re craving rather than deny the craving. Eat ing around a craving may only cause you to eat more because the craving isn’t satisfied.

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SPECIAL SECTION

Healthy recipes

On most nights of the week, you may be too

busy and tired to cook elaborate dishes. On those nights, try some of the suggestions listed in “Easy go-to dishes you can prepare without a recipe,” page 32. But when time allows—perhaps twice a week—try preparing more complicated dishes

as a treat for your palate. You’ll find out just how deli cious and rewarding healthy eating can be.

Appetizers, soups, and salads

Beet and White Bean Hummus

➤ Makes 12 servings (about 3 tablespoons per serving) Active prep time: 15 minutes

You can find thousands of recipes online, but this selection will get you started with some dishes that we know are healthy. These recipes were developed, tested, and photographed by registered dietitian Sha

ron Palmer, the nutrition editor of this report. All the recipes include a nutritional analysis. (Optional ingredients, such as salt, are not included in the analysis.)

1 (15-ounce) can cannellini or white beans, rinsed, drained

3 medium cooked beets, drained, chopped (about 1 cup)

1 large clove garlic, minced Juice of 1 small lemon 1½ tablespoons tahini

1 tablespoon extra-virgin olive oil

½ teaspoon paprika

¼ teaspoon red chili pepper flakes

Salt (optional)

Fresh mint or other herbs for garnish (optional)

Balsamic vinegar for garnish (optional)

Add beans, beets, garlic, lemon juice, tahini, olive oil,

paprika, and red chili pepper flakes to a blender container

and blend until smooth. Season with salt as desired. Pour

into a serving container and garnish if desired with fresh

mint or other herbs, a drizzle of balsamic vinegar, and

additional olive oil. Chill before serving.

Nutrition information per serving: 68 calories, 3 g protein, 2 g fat,

0 g saturated fat, 10 g carbohydrate, 2 g fiber, 1 g sugar, 14 mg sodium.

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SPECIAL SECTION | Healthy recipes

Classic Bruschetta

➤ Makes 2 servings (1 heaping cup per serving) Active prep time: 10 minutes

Kabocha Squash Leek Soup with Pistachios ➤ Makes 6 servings

Active prep time: 30 minutes

2 cups diced ripe tomatoes ¼ cup diced white onion 2 cloves garlic, minced

1 tablespoon extra-virgin olive oil

1 tablespoon red wine vinegar

½ teaspoon dried oregano ½ teaspoon dried basil (or

1 small (about 2 pounds) kabocha squash (or another squash)

2 tablespoons extra-virgin olive oil, divided

1 leek, trimmed, sliced (white and green parts)

2 cloves garlic, minced 1 teaspoon dried tarragon

1 teaspoon dried oregano 1 teaspoon dried marjoram

½ cup pistachios (plus more for garnish)

2 bay leaves

3 cups vegetable broth

1 cup milk or plant-based milk (e.g., soy milk)

Salt and pepper (optional)

2 tablespoons chopped fresh basil)

Salt and pepper (optional)

Preheat oven to 400° F. Slice squash in half, scoop out seeds, and then slice each half into four pieces. Place in a

Toss together all ingredients and let stand for 30 minutes. Serve at room temperature as an accompaniment for toasted bread (or veggie burgers, pasta, or a nut loaf).

Nutrition information per serving: 57 calories, 1 g protein, 4 g fat, 1 g saturated fat, 6 g carbohydrate, 1 g fiber, 3 g sugar, 6 mg sodium.

French Wild Rice Vegetable Soup

➤ Makes 6 servings (about 11/3 cups per serving) Active prep time: 15 minutes

baking dish in ½ inch of water. Drizzle with 1 tablespoon of the olive oil. Bake for about 35 to 40 minutes, just until tender when pierced with a fork. Remove squash from oven and allow

to cool slightly. Scoop

out cooked squash from

the peel with a spoon

and set aside. Heat the

remaining 1 tablespoon

olive oil in a large pot.

Add leek and garlic and

1 (14.5-ounce) can diced tomatoes

½ cup uncooked wild rice 1 medium carrot, sliced 1 small zucchini, sliced

1 small leek, sliced (about 1 cup)

2 cloves garlic, minced 1 cube vegetable bouillon

1 teaspoon Herbes de Provence (seasoning blend)

Dash black pepper

sauté for 8 minutes. Add tarragon, oregano, marjoram, and pistachios and sauté for another minute. Add bay leaves, vegetable broth, and cooked squash and bring to a simmer, cooking for about 5 minutes. Remove

Place all ingredients in a large pot with 5 cups water. Cover with a tight lid and bring to a boil. Reduce heat to a simmer and cook for

about 1 hour, until wild rice

and vegetables are tender.

If needed, add additional

water to replace water lost

in evaporation. The result

should be a thick, hearty

soup.

Nutrition information per

serving: 92 calories, 4 g protein,

1 g fat, 0 g saturated fat, 19 g

carbohydrate, 3 g fiber, 2 g sugar,

379 mg sodium.

bay leaves and turn off

heat. Add milk. Use immersion blender to blend soup until smooth and creamy, or place soup in a blender container and puree. Add salt and pepper (if desired). Reheat soup on medium heat just to a simmer. Remove from heat. Serve in bowls and garnish with additional pistachios if desired.

Nutrition information per serving: 170 calories, 5 g protein, 10 g fat, 1 g saturated fat, 18 g carbohydrate, 3 g fiber, 5 g sugar, 297 mg sodium.

44 A Guide to Healthy Eating www.health.harvard.edu This Harvard Health Publication was prepared exclusively for LIUDMILA OLENEVA - Purchased at https://www.health.harvard.edu

Healthy recipes | SPECIAL SECTION

Spicy Cauliflower Cilantro Salad

➤ Makes 8 servings (¾ cup per serving)

Active prep time: 15 minutes

1 head (1½ pounds) cauliflower, washed and broken into small florets (about 5 cups)

1 cup frozen peas (or fresh peas, blanched)

½ small red onion, halved and sliced Juice of ½ lemon

1½ tablespoons extra-virgin olive oil 1 clove garlic, minced

1 small jalapeno pepper, seeded, finely diced (for a milder dish, use only half)

½ teaspoon turmeric

½ teaspoon cumin

¼ teaspoon black pepper

Kosher salt (optional)

½ cup chopped fresh cilantro

Fill a medium pot halfway with water. Cover and bring to a boil. Remove pot

from heat, add cauliflower pieces, and allow to sit for 1 minute. Drain cauliflower in a colander. Rinse with cold water just to cool. Place cauliflower, peas, and red

onion in a large salad bowl. In a small bowl, whisk together lemon juice, olive

oil, garlic, jalapeno, turmeric, cumin, black pepper, and salt (if using). Drizzle over

cauliflower mixture and toss together. Stir in cilantro and serve immediately.

Nutrition information per serving: 56 calories, 2 g protein, 3 g fat, 0 g saturated fat, 7 g carbohydrate, 3 g fiber, 3 g sugar, 34 mg sodium.

Mandarin, Quinoa, and Kale Bowl ➤ Makes 6 servings

Active prep time: 15 minutes

Arugula Salad with Radishes and Avocado and Truffle Lemon Vinaigrette

➤ Makes 4 servings

1 bunch kale, washed, dried, and chopped

3 tablespoons orange juice

1 tablespoon extra-virgin olive oil

1 teaspoon cumin

½ teaspoon turmeric

¼ teaspoon red chili flakes

¼ cup chopped fresh cilantro

1 cup cooked quinoa

3 fresh mandarin oranges, peeled, segmented

3 tablespoons sunflower seeds

Active prep time: 10 minutes 4 cups torn arugula leaves

6 radishes, assorted colors, trimmed and thinly sliced

1 avocado, sliced

¼ cup pepitas (pumpkin seeds), shelled

1 tablespoon truffle

Place kale in a large mixing bowl. In a small bowl, whisk together orange juice, olive oil, cumin, turmeric, red chili flakes, and cilantro to

make dressing. Toss dress

ing into kale using tongs,

carefully distributing and

coating leaves. Mix in

cooked quinoa, mandarin

oranges, and sunflower

seeds.

Nutrition information per

serving: 119 calories,

4 g protein, 5 g fat, 1 g saturated

fat, 15 g carbohydrate, 3 g fiber,

3 g sugar, 29 mg sodium.

flavored olive oil

1 tablespoon lemon juice

Pinch sea salt

Freshly ground black

pepper

Toss together arugula, radishes, avocados, and pepitas. Drizzle with truffle-flavored olive oil and lemon juice. Sprinkle with sea salt and freshly ground black pepper.

Nutrition information per serving: 72 calories, 2 g protein, 6 g fat, 1 g saturated fat, 5 g carbohydrate, 1 g fiber, 3 g sugar, 309 mg sodium.

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SPECIAL SECTION | Healthy recipes Entrees and side dishes

Easy Baja Fish Tacos with Salsa ➤ Makes 3 servings (2 tacos per serving) Active prep time: 30 minutes

For the crispy fish:

Asian Salmon with Kale and Tomatoes ➤ Makes 4 servings

Active prep time: 20 minutes

1 tablespoon sesame oil

½ cup cornmeal

½ teaspoon salt

1 teaspoon chili powder ½ teaspoon garlic powder

2 eggs, beaten

12 ounces fish fillets, sliced into 6 (2-inch) strips

(about 2 ounces each) 2 tablespoons olive oil

or olive oil

½ cup thinly sliced red onion

3 cloves garlic, minced 1 teaspoon grated fresh

For the tomato cabbage slaw:

ginger plus 4 slices,

1 cup shredded red

cabbage

½ cup canned fire-roasted tomatoes, diced, drained For the avocado crema: ½ cup plain Greek yogurt 1 avocado, mashed

¼ cup chopped fresh cilantro

For assembling the tacos:

Juice of 1 lime

Salt and pepper to taste

1 large clove garlic, minced Juice of ½ lime

divided (see note)

4 cups torn or roughly chopped kale, stems cut into ¼-inch slices

½ cup low-sodium veg etable or chicken broth

2 tablespoons plus 4 tea spoons low-sodium soy sauce, divided

½ teaspoon red pepper

1 pound salmon fillet, cut into 4 portions

4 thin slices lemon

6 (6-inch) corn tortillas ¾ cup prepared salsa

To prepare crispy fish: In a small, shallow bowl, mix together the cornmeal, salt, chili powder, and garlic pow

flakes

1 cup cherry tomatoes, halved

1 teaspoon toasted sesame seeds or toasted slivered almonds

der. Place beaten eggs in a second small shallow bowl. Dip fish strips into the beaten egg and then coat well with cornmeal mixture. Heat the olive oil in a sauté pan or skillet over medium heat. Place coated fish fillet strips in the pan and cook until they are golden brown and flake easily with a fork (about 3 minutes on each side). To prepare tomato cabbage slaw: Toss together shred ded cabbage, roasted tomatoes, and lime juice in a bowl. Season with salt and pepper to taste.

To prepare avocado crema: Blend yogurt, avocado, cilan tro, garlic, and lime juice.

To assemble tacos, briefly

warm tortillas in a pan and

then top each tortilla with ¼

cup tomato-cabbage slaw, 1

fish strip, 2 tablespoons salsa,

and 2 tablespoons avocado

crema.

Nutrition information per serving:

541 calories, 35 g protein, 23 g fat,

4 g saturated fat, 54 g carbohydrate,

11 g fiber, 9 g sugar, 679 mg sodium.

Heat oil in a 12-inch skillet over medium-high heat. Add onion and sauté until softened. Add garlic and 1 teaspoon grated ginger and sauté another minute. Add kale, using tongs to quickly turn and coat the leaves with oil. Add broth, 2 tablespoons soy sauce, and red pepper flakes, continuing to turn the mixture. When kale is just wilted, add tomatoes and salmon portions, placing the fillets directly against the bottom of the skillet. Top each fillet with 1 slice of ginger, 1 slice of lemon, and 1 tea spoon of soy sauce. Cover skillet and cook until salmon is done, about 6 to 8 minutes depending on thickness. Serve salmon on a bed of kale and tomatoes. Sprinkle with sesame seeds or almonds and additional red pepper flakes if desired.

Note: Instead of fresh ginger, you can use ¼ teaspoon ginger powder, plus a dash of powder on each fillet.

Nutrition information per serving: 550 calories, 26 g protein, 12 g fat, 2 g saturated fat, 13 g carbohydrate, 2 g fiber, 2 g sugar, 562 mg sodium.

46 A Guide to Healthy Eating www.health.harvard.edu This Harvard Health Publication was prepared exclusively for LIUDMILA OLENEVA - Purchased at https://www.health.harvard.edu

Chipotle Black Bean Quinoa Veggie Burgers ➤ Makes 10 servings

Active prep time: 20 minutes

Healthy recipes | SPECIAL SECTION

Stir-Fried Thai Tofu Sorghum Bowl

➤ Makes 4 servings

Active prep time: 30 minutes

2 cups cooked quinoa, cooled

1 (15-ounce) can vegetar ian refried black beans

½ bell pepper, finely chopped

¼ red onion, finely diced 1 medium carrot, shredded

2 tablespoons chopped fresh cilantro

¼ cup light mayonnaise

½ cup whole-grain bread crumbs

1 teaspoon chipotle seasoning

Salt to taste (optional)

For the sorghum bowl: 2 cups cooked sorghum (prepared according to package directions)

4 teaspoons peanut oil, divided

2 cups chopped asparagus spears

2 carrots, peeled and sliced

2 cloves garlic, minced 1 red bell pepper, cored and sliced

1½ cups sliced snow peas 1 tablespoon low-sodium, gluten-free soy sauce

1 (15-ounce) package extra-firm tofu, cut into

Preheat oven to 375° F. Combine all ingredients in a mixing bowl and stir together until smooth. Spray a baking sheet with nonstick cooking spray. Scoop up a ½-cup portion of the mixture and form a patty about 3 inches in diameter and 1 inch thick. Put on baking sheet and repeat to make a total of 10 patties. Bake about 40 to 45 minutes until patties are crispy and firm. Remove and serve as desired—for example, in a bun with lettuce, tomatoes, and avocado and topped with chipotle mayonnaise; over a bed of salad greens; as a patty with mashed potatoes and mushroom sauce; in an open-face

1 tablespoon grated ginger For the Thai sauce:

1 cup canned light coconut milk

1 tablespoon Thai red curry paste

1/3 cup creamy peanut butter

1 tablespoon low-sodium, gluten-free soy sauce

1-inch cubes

2½ tablespoons maple syrup

1 clove garlic, minced 2 teaspoons minced fresh ginger

1 teaspoon cornstarch

toasted sandwich.

Nutrition information per serving: 126 calories, 5 g protein, 3 g fat, 0 g saturated fat, 19 g carbohydrate, 4 g fiber, 2 g sugar, 270 mg sodium.

Divide the cooked sorghum among four bowls and set aside. Heat 2 teaspoons of the peanut oil in a large nonstick skillet or wok over medium-high heat. Add the asparagus, carrots, ginger, and garlic and stir-fry for 1 min ute. Add 1 tablespoon water to the skillet and cover; let the vegetables steam for about 2 minutes, until bright and tender. Add the red bell pepper, snow peas, and soy sauce to the skillet. Cook, stirring constantly, 3 to 4 minutes more, or until all the vegetables are tender-crisp. Remove the vegetables and wipe the skillet clean with a paper towel. Return the skillet to medium-high heat. Add the remaining 2 teaspoons peanut oil and swirl to coat, then add the tofu. Cook, turning occasionally, until the tofu is lightly browned and crisp on all sides, about 5 minutes.

Meanwhile, whisk together all of the ingredients for the Thai sauce, then pour the sauce over the browned tofu in the skillet. Cook for 4 to 5

minutes more until the sauce

has thickened and the tofu is

coated. Add the vegetables

back to the skillet and toss once

more to coat. Top the sorghum

with the vegetables and tofu.

Nutrition information per serving:

416 calories, 20 g protein, 17 g fat, 5 g

saturated fat, 54 g carbohydrate, 5 g fiber,

7 g sugar, 610 mg sodium.

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SPECIAL SECTION | Healthy recipes

Nourishing Lentil Bowl with Winter Vegetables ➤ Makes 6 servings

Active prep time: 25 minutes

Pasta with Marinara and Roasted Vegetables ➤ Makes 4 servings

Active prep time: 25 minutes

2-pound winter squash (e.g., butternut, acorn), peeled and chopped (about 3 cups)

1 red or white onion, sliced 2 cups sliced mushrooms 2 cloves garlic, minced 2 tablespoons olive oil 1 tablespoon balsamic vinegar

2 teaspoons Italian season ing (or 2 tablespoons

Salt and pepper (optional) 7 cups cooked French green lentils (see note)

1 cup pomegranate

seeds (from 1 large

pomegranate)

¾ cup pecans

Greens, such as arugula, basil, or spinach

(optional)

3 assorted small summer squash (e.g., scallop, yellow, zucchini), sliced

1 small eggplant, sliced ½ red onion, sliced

1 bell pepper (red, yellow, or green), sliced

2 tablespoons extra-virgin olive oil

1 tablespoon red wine vinegar

3 cloves garlic, finely diced

2 teaspoons ground

oregano

¼ teaspoon freshly ground black pepper

Sea salt to taste (optional) 2 tablespoons pine nuts 12 ounces fresh pasta (may

substitute 8 ounces dried pasta)

2 cups marinara sauce ¼ cup chopped fresh basil

minced fresh herbs, such

as oregano, thyme, and

rosemary)

Preheat oven to 375° F. On a large baking sheet, evenly arrange chopped squash, onion, mushrooms, and garlic. In a small bowl, mix olive oil, vinegar, seasoning, and salt and pepper (if desired). Drizzle over vegetables and toss to distribute evenly. Place on top rack in oven and roast until vegetables are golden brown and tender (30 to 35 minutes). Divide lentils among six individual serving bowls (1 heaping cup each). Divide roasted vegetables among the bowls (about 1 cup each). Top each bowl with about 3 tablespoons pomegranate seeds and 2 tablespoons pecans. If desired, garnish with greens.

Note: You can use prepared, seasoned lentils (refrigerated or canned) or make them from scratch as follows: In a medium pot, combine 1 pound dried French green lentils, 1 cup white wine, 4 cups water, 1 vegetable bouillon cube, 2 teaspoons Italian seasoning (or fresh herbs such as rosemary, basil, thyme, and oregano), and salt and pepper if desired. Cover and bring to a simmer. Cook for 35 to 40 minutes, just until tender yet firm. Makes 7 cups cooked lentils.

Nutrition information per serving: 482 calories, 23 g protein, 15 g fat, 2 g saturated fat, 66 g carbohydrate, 27 g fiber, 10 g sugar, 260 mg sodium.

Preheat oven to 400° F. Arrange summer squash, egg plant, onion, and bell pepper on a baking sheet. Drizzle with olive oil and vinegar. Sprinkle with garlic, oregano, black pepper, and sea salt (if using). Toss together on pan to distribute ingredients. Place on top rack in oven and roast for about 30 minutes, until vegetables are golden brown and tender. While vegetables are roasting, place pine nuts in a small baking dish in the hot oven for about 5 minutes to toast; remove and set aside. Meanwhile, bring a medium pot of water to boil. Add pasta and cook to al dente stage (according to package directions). Place in colander; rinse and drain. Add marinara sauce to pot and heat until bubbling. Remove from heat and add cooked pasta, stirring gently to distribute ingredients. Divide pasta with marinara sauce among four pasta bowls (or plates). Top with roasted vegetables, pine nuts, and basil.

Nutrition information per serving: 369 calories, 10 g protein, 14.5 g fat, 2 g saturated fat, 54 g carbohydrate, 10 g fiber, 18 g sugar, 116 mg sodium.

48 A Guide to Healthy Eating www.health.harvard.edu This Harvard Health Publication was prepared exclusively for LIUDMILA OLENEVA - Purchased at https://www.health.harvard.edu

Spaghetti Squash with Ratatouille ➤ Makes 4 servings

Active prep time: 20 minutes

Healthy recipes | SPECIAL SECTION

Vegetable-Bean Fajitas

➤ Makes 4 servings (2 tortillas per serving) Active prep time: 20 minutes

1 small spaghetti squash, quartered

1 tablespoon extra-virgin olive oil

1 onion, diced

1 small eggplant, chopped 1 medium zucchini,

chopped

2 cloves garlic, minced 1 (14.5-ounce) can unsalted diced tomatoes, with liquid

1 teaspoon basil

1 teaspoon oregano

1 teaspoon marjoram

¼ teaspoon black pepper Salt (optional)

1 tablespoon capers, rinsed, drained

½ cup whole

Mediterranean olives, rinsed, drained

1 tablespoon balsamic vinegar

1 teaspoon honey

2 teaspoons extra-virgin olive oil

1 large onion, sliced

1 green bell pepper, sliced 1 red bell pepper, sliced 2 small zucchinis, sliced 4 ounces fresh mushrooms, sliced

2 cloves garlic, minced ¼ jalapeño pepper, finely diced

1 tablespoon fresh lemon juice

1 teaspoon cumin

1 teaspoon chili powder ¼ cup chopped fresh cilantro

2 cups unsalted cooked beans (e.g. pinto,

cranberry, red)

8 small corn tortillas 1 cup guacamole (make your own with mashed avocado, lemon juice, and garlic)

1 cup salsa (look for lower

Scoop out the seeds from the spaghetti squash and place the squash quarters in a medium pot with enough water to cover them. Bring to a boil and cook for about 20 minutes, until tender. Remove from pot and place on a cutting board to cool slightly. While squash is cooking, heat olive oil in a large sauté pan or skillet. Sauté onions, eggplant, zucchini, and garlic for 10 minutes. Add toma toes, ½ cup water, basil, oregano, marjoram, pepper, salt (if using), capers, olives, vinegar, and honey. Cover and cook for 10 minutes, stirring occasionally, until vegeta bles are tender and mixture is thick. With a fork, gently loosen and separate strings of squash from the squash peels. Place squash quarters on dinner plates or a platter. Top with ratatouille and serve immediately.

Nutrition information per serving: 100 calories, 1 g protein, 5 g fat, 0 g saturated fat, 15 g carbohydrate, 3 g fiber, 5 g sugar, 371 mg sodium.

sodium brands)

Heat olive oil in a large skillet (cast iron works best). Add onion, bell pepper, zucchini, mushrooms, garlic, and jalapeño, and sauté for about 10 minutes, until just tender. Add lemon juice, cumin, and chili powder, and stir well. Sprinkle with chopped cilantro. Heat beans in a small pot or microwave. To serve, fill tortilla shells with beans and vegetable mixture, and garnish with guacamole and salsa.

Nutritional information per serving: 385 calories, 14 g protein, 11 g fat, 0 g saturated fat, 63 g carbohydrate, 14 g fiber, 6 g sugar, 235 mg sodium.

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SPECIAL SECTION | Healthy recipes

Broccoli Walnut Au Gratin ➤ Makes 8 servings

Active prep time: 15 minutes

Healthy Buffalo Cauliflower with Ranch Dip ➤ Makes 8 servings

Active prep time: 20 minutes

1½ pounds fresh broccoli or broccolini, chopped

¼ cup whole-wheat bread crumbs

1 cup shredded, sharp plant-based cheese

(soy, almond) or low-fat cheese, divided

½ cup coarsely chopped walnuts

1 tablespoon fresh

rosemary (or 1 teaspoon dried)

2 tablespoons extra-virgin olive oil, divided

½ onion, diced

1 clove garlic, minced 2 tablespoons flour

¾ cup vegetable broth 1 cup low-fat milk or plain soy milk

½ teaspoon black pepper Salt (optional, to taste)

For the cauliflower:

1 cup flour (use gluten-free flour, such as sorghum or rice flour, to make this recipe gluten-free)

¾ teaspoons garlic powder 1 teaspoon paprika

½ teaspoon salt (optional) 2 teaspoons white vinegar

For the ranch dip:

½ cup light mayonnaise 1/3 cup low-fat milk or soy

2 tablespoons extra-virgin olive oil

2 to 4 tablespoons hot sauce (based on your preference for spiciness)

2 tablespoons sweet chili sauce or ketchup

2 medium heads cauli flower, split into florets

3 tablespoons assorted chopped fresh herbs

Preheat oven to 375° F. Bring a medium pot of water to boil. Place broccoli in pot, cover, and cook for about 8 minutes, until just tender but bright green. Drain, and transfer cooked broccoli to a 9-inch casserole dish. Spray a baking dish or baking sheet with nonstick cooking spray. In a small bowl, combine bread crumbs, ¼ cup of the shredded cheese, walnuts, rosemary, and 1 tablespoon of the olive oil, mixing well. Transfer walnut crumb mixture to the baking dish or sheet and place on top rack in oven. Bake 15 minutes until golden brown. Remove from oven and set aside. Meanwhile, heat the remaining 1 tablespoon olive oil in a saucepan and add onions and garlic, sautéing for 5

minutes. Add flour and

cook an additional

minute. Stir in broth

and milk and cook for

an additional minute.

Stir in the remaining ¾

cup shredded cheese

milk

1 teaspoon white vinegar 1 clove garlic, minced

For garnish:

Celery sticks

Preheat oven to 450° F. Spray a baking

sheet with non

stick cooking spray and set aside. In a

medium bowl, mix

together flour, garlic powder, paprika, and salt (if using). Stir in 1 cup water, vinegar,

olive oil, hot sauce, and chili sauce or

(e.g., dill, basil, oregano, chives, parsley, cilantro, tarragon)

¼ teaspoon paprika

Pinch salt (optional)

and black pepper, and

heat until thick and

creamy. Season with

salt if desired. Pour

sauce evenly over

broccoli in casserole

dish. Sprinkle with

crumb walnut mixture.

Serve.

Nutrition information per serving: 197 calories, 9 g protein, 13.5 g fat, 4 g saturated fat, 13 g carbohydrate, 3 g fiber, 3 g sugar, 208 mg sodium.

ketchup until smooth to make a batter. Dip the cauli flower florets into the batter and arrange evenly on the baking sheet. Drizzle any remaining batter over the cau liflower florets. Place on top rack in oven and roast for 25 to 30 minutes, until cauliflower is golden brown and tender. Meanwhile, prepare the ranch dip by mixing all ingredients together in a small bowl until smooth. Place the ranch dip in a serving bowl, arrange hot cauliflower on a platter, and serve with celery sticks on the side.

Nutrition information per serving (cauliflower only): 129 calories, 4 g protein, 4 g fat, 1 g saturated fat, 21 g carbohydrate, 4 g fiber, 5 g sugar, 254 mg sodium.

Nutrition information per serving (ranch dip only): 41 calories, 0 g protein, 4 g fat, 0 g saturated fat, 2 g carbohydrate, 0 g fiber, 0 g sugar, 115 mg sodium.

50 A Guide to Healthy Eating www.health.harvard.edu This Harvard Health Publication was prepared exclusively for LIUDMILA OLENEVA - Purchased at https://www.health.harvard.edu

Chana (Chickpea) Masala with Brown Rice ➤ Makes 8 servings

Active prep time: 15 minutes

Healthy recipes | SPECIAL SECTION

Greek Gigantes Beans

➤ Makes 8 servings

Active prep time: 15 minutes

2 cups dried gigantes beans (large lima beans)

1 onion, diced

3 cloves garlic, minced 3 carrots, diced

½ cup tomato paste

1 teaspoon oregano

1 teaspoon rosemary 1 teaspoon marjoram ½ teaspoon thyme

¼ teaspoon black pepper Salt to taste

1½ tablespoons extra virgin olive oil

1½ tablespoons vegetable oil

1 onion, diced

1 small (or ½ large) green chili, finely diced

1 tablespoon grated fresh ginger

4 cloves garlic, minced 1 tablespoon ground cumin 2 teaspoons ground coriander

½ teaspoon ground

mustard

1 teaspoon ground turmeric ½ teaspoon sea salt (optional)

½ teaspoon black pepper 1 (14-ounce) can diced tomatoes (unsalted),

with liquid

1 (14-ounce) can tomato sauce

½ cup finely chopped fresh cilantro (reserve some for garnish)

2 (15-ounce) cans chick peas (unsalted), rinsed, drained (about 3½ cups)

2 teaspoons garam masala Juice of ½ lemon

4 cups cooked brown rice (prepared according to package directions)

Place beans in a pot, cover with water, and soak over night. Drain water, add 4 cups fresh water, onion, garlic, carrots, tomato paste, oregano, rosemary, marjoram, thyme, and black pepper. Cover, bring to a boil, reduce heat to medium-low, and simmer for about 1½ hours, stirring occasionally. Add water to replace that lost to evaporation. The result should be a thick stew. Season with salt, as desired. Drizzle with olive oil.

Nutrition information per serving: 204 calories, 11 g protein, 3 g fat, 0.5 g saturated fat, 35 g carbohydrate, 10 g fiber, 7.5 g sugar, 40 mg sodium.

Heat oil in a large sauté pan, skillet, or pot and add

onion, chili, ginger, garlic, cumin, coriander, mustard,

turmeric, salt (if using), and black pepper and sauté for

9 minutes, stirring frequently. Add canned tomatoes

(including the liquid) and tomato sauce. Add cilantro

(reserving some for garnish) and chickpeas, stirring

well to combine. Cover with a lid and cook for 20 to 25

minutes, until thickened. Add garam masala and lemon

juice and mix well. Serve over brown rice. Garnish with

remaining cilantro.

Nutrition information per serving: 362 calories, 14 g protein,

7 g fat, 1 g saturated fat, 64 g carbohydrate, 12.5 g fiber, 9 g sugar,

86 mg sodium.

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SPECIAL SECTION | Healthy recipes Fruit and desserts

Oats and Spiced Nut Butter with Apples ➤ Makes 1 serving

Active prep time: 8 minutes

Banana Coconut Brown Rice Pudding ➤ Makes 8 servings

Active prep time: 15 minutes

½ cup low-fat milk or plain unsweetened soy milk ½ cup uncooked old fashioned rolled oats 1½ tablespoons almond butter

½ teaspoon pure maple

¼ teaspoon ground

cinnamon

¼ teaspoon ground ginger ½ apple with peel, chopped 1 teaspoon chopped almonds

1 cup uncooked brown basmati rice

21/3 cups unsweetened vanilla-flavored coconut milk

1 tablespoon cornstarch 1 teaspoon cinnamon

½ teaspoon cardamom 2 tablespoons agave nectar 4 small (5 ounces each)

ripe bananas, divided ¼ cup unsweetened shredded coconut or coconut flakes

syrup (optional)

In a medium saucepan, bring ½ cup water and milk to a boil. Stir in oats. Cook uncovered over medium heat for 5 minutes, stirring occasionally. In a small bowl, stir

together almond butter, pure maple syrup (if using), cin namon, and ginger, adding water 1 tablespoon at a time if mixture seems too thick. Stir into hot oatmeal. Top with chopped apple and almonds.

Nutrition information per serving: 420 calories, 13 g protein, 21 g fat, 2.5 g saturated fat, 51 g carbohydrate, 8.5 g fiber, 14 g sugar, 63 mg sodium.

Cinnamon Apple Crumble

➤ Makes 8 servings

Active prep time: 25 minutes

Place the rice and 2 cups water in a pot, cover, and cook for 30 minutes, stirring occasionally. Drain off any extra water. Meanwhile, in a medium bowl, whisk together the coconut milk and cornstarch with a wire whisk until smooth. When the rice has cooked for 30 minutes, add the coconut milk mixture, cinnamon, cardamom, and agave nectar, and continue to cook, stirring occasionally, for 15 minutes, until the mixture has thickened into the consistency of porridge and the rice is tender. Mash 2 of the bananas and stir into rice pudding. Slice the remain ing 2 bananas. To serve, place rice pudding in a serving bowl or individual serving dishes (2/3 cup each). Top with sliced bananas and shredded coconut (for individual servings, ¼ sliced banana and ½ tablespoon shredded coconut per serving). Serve immediately.

Nutrition information per serving: 113 calories, 3 g protein, 2 g fat,

5 medium apples (5 ounces each), peeled, cored, sliced ½ cup orange juice

½ teaspoon cinnamon 2/3 cup uncooked old fashioned rolled oats 1/3 cup quinoa flour (see note)

¼ cup coarsely chopped walnuts

1 teaspoon cinnamon 1 tablespoon brown sugar 3 tablespoons soft

margarine spread

1 g saturated fat, 23 g carbohydrate, 2 g fiber, 10 g sugar, 35 mg sodium.

Green Pistachio Smoothie

➤ Makes 1 serving

Active prep time: 5 minutes

1 cup chopped kale

Preheat oven to 375° F. Toss apple slices, orange juice, and cinnamon together and arrange in a 10-inch pie dish. Stir together oats, flour, walnuts, cinnamon, and brown sugar. Mix in margarine spread with a fork to make a crumbly dough. Sprinkle crumb topping over apple filling. Bake for about 1 hour, until topping is golden brown and apples are tender yet firm. Serve while warm.

Note: You may substitute a different type of whole-grain flour, such as whole-wheat (contains gluten), sorghum, or millet flour.

Nutrition information per serving: 137 calories, 2 g protein, 4 g fat, 1 g saturated fat, 26 g carbohydrate, 4 g fiber, 13 g sugar, 35 mg sodium.

¾ cup orange juice

½ banana, peeled

¼ cup pistachios

¼ avocado, peeled

Place all ingredients into the

container of a blender and

process. Enjoy your fresh and

healthy smoothie!

Nutrition information per serving: 410 calories, 11.5 g protein, 20 g fat, 2.5 g saturated fat, 53 g carbohydrate, 9 g fiber, 25 g sugar, 37 mg sodium.

52 A Guide to Healthy Eating www.health.harvard.edu This Harvard Health Publication was prepared exclusively for LIUDMILA OLENEVA - Purchased at https://www.health.harvard.edu

Resources

Organizations

Academy of Nutrition and Dietetics

120 S. Riverside Plaza, Suite 2000

Chicago, IL 60606

800-877-1600 (toll-free)

www.eatright.org

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

The Nutrition Source—Knowledge for Healthy Eating Harvard T.H. Chan School of Public Health

Department of Nutrition

www.hsph.harvard.edu/nutritionsource

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

Books

The Art of Fermentation

Sandor Ellix Katz

(Chelsea Green Publishing, 2012)

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

Glossary

body mass index (BMI): An estimate of the body’s fat content, calculated from measurements of height and weight.

dietary fiber: The edible, nondigestible component of carbohy drates naturally found in plant food.

dietary reference intakes (DRIs): A comprehensive set of standards for daily intake of essential vitamins and minerals, based on evidence from scores of observational and clinical studies.

essential amino acids: The nine amino acids (building blocks of protein) that the body cannot synthesize for itself.

essential fats: Beneficial polyunsaturated fats, including both omega-3 and omega-6 fatty acids, that come exclusively from foods and supplements; they are not manufactured by the body.

macronutrients: The basic categories of nutrients that humans need for energy and metabolism: fat, carbohydrate, and protein.

micronutrients: The vitamins and minerals that humans need to maintain normal body functions and prevent certain illnesses.

monounsaturated fats: Beneficial fats found in foods like olive oil, avocados, and nut oils. They decrease the risk of cardiovascular disease and type 2 diabetes because they help improve blood cholesterol levels and your body’s responsiveness to insulin.

omega-3 fatty acids: Beneficial fats found in fatty fish like salmon, mackerel, and sardines, plus some plant foods, such as

Eat, Drink, and Be Healthy: The Harvard Medical School Guide to Healthy Eating

Walter C. Willett, M.D., with P.J. Skerrett

(Simon & Schuster, 2017)

This book, written by a noted nutrition expert at Harvard, provides research-based information about the links between diet and health. An extensive selection of recipes helps readers put the latest nutrition findings into practice.

Eat, Drink, and Weigh Less: A Flexible and Delicious Way to Shrink Your Waist Without Going Hungry

Mollie Katzen and Walter C. Willett, M.D.

(Hyperion, 2007)

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

The Plant-Powered Diet

Sharon Palmer, R.D., L.D.N.

(The Experiment, 2012)

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

walnuts, flaxseeds, and chia. They help reduce blood pressure, lower triglycerides, and prevent heart rhythm disorders.

omega-6 fatty acids: Polyunsaturated fats found in many veg etable oils. They are beneficial, provided you don’t eat too many.

phytochemicals: Substances made by plants that have biological effects in the human body. Some are phytoestrogens, chemicals that behave like (or sometimes block the action of) the hormone estrogen.

polyunsaturated fats: Beneficial fats including both omega-3 and omega-6 fatty acids.

processed foods: Foods that are refined, stripped of many nutrients, and mixed with other ingredients to form new products.

saturated fats: Unhealthy fats found mainly in animal products, such as meat and full-fat milk, cheese, and butter. People who replace saturated fats with polyunsaturated fats reduce their risk for heart disease.

trans fats: Unhealthy fats in the food supply that used to come mainly from processed foods made with hydrogenated oils. Trans fats have recently been banned from processed foods, but they do occur naturally in small amounts in beef, lamb, and milk.

whole foods: Foods consumed in their most natural forms, with no processing or only minimal processing.

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