Healthwise

Never eat more than you can lift.
Miss Piggy

Chapter 18

Nutrition

This chapter gives some guidelines for good eating and some hints on how to help your children establish healthy eating habits. Children learn best by example, so teach them by practicing good eating habits along with them. For more information about healthy eating, see Resource 62 on page 310.

Seven Simple Guidelines for Eating Well

(Dietary Guidelines for Americans, USDA, 1995)

Eat a variety of foods. Include a daily selection of:

Whole-grain and enriched breads, cereals, and grain products
Vegetables
Fruits
Milk, cheese, and yogurt
Meats, poultry, fish, eggs, dried beans and peas, tofu

Balance the food you eat with physical activity-maintain or improve your weight. See page 266.

Choose a diet low in fat, saturated fat, and cholesterol. Fats have twice as many calories per gram as any other food. A high-fat diet increases your risk of heart disease and some cancers. See page 259.

Choose a diet with plenty of grain products, vegetables, and fruits. Complex carbohydrates (grains, vegetables, and starches) and fruits pack the most nutrients per calorie. See page 256.

Choose a diet moderate in sugars. Sugars have little, if any, vitamins, minerals, or fiber. See page 259.

Choose a diet moderate in salt and sodium. For some people, sodium increases blood pressure. See page 265.

If you drink alcoholic beverages, do so in moderation. Alcohol is high in calories and has no nutrients. For men, this means not more than two drinks per day; for women, not more than one. A drink is equal to 12 ounces of beer, five ounces of wine, or 1 l/2 ounces of distilled alcohol (vodka, gin, etc.).

Eating Well: A Basic Plan

Eat a variety of foods from the Food Guide Pyramid every day. Eat more from the breads and cereals and fruits and vegetables groups than from the other groups. Most people who follow this plan will get all the vitamins, minerals, and other nutrients their bodies need and will have little trouble controlling their weight.

Breads, Cereals, and Starches

Contrary to popular belief, bread, potatoes, rice, and pasta are not fattening! These starchy foods are actually good for you.

Starches are carbohydrates, which have less than half the calories per gram as fat. Unprocessed starches (whole grains, vegetables) also contain large amounts of vitamins, minerals, fiber, and water.

Starchy foods are fattening only when you add fat to them. Try nonfat yogurt or salsa on baked potatoes. Use fresh vegetable and tomato sauces on pasta.

Fruits and Vegetables

Fresh fruits and vegetables are good for you. They provide vitamins, min- erals, and fiber and are naturally low in fat. Many fruits and vegetables, contain a lot of vitamins A (beta carotene), and C, especially oranges and other citrus fruits, broccoli, sweet potatoes, winter squash, carrots, spinach, and other leafy greens. As a result, a diet that includes lots of fruits and vegetables can help protect you against heart disease, stroke, and cancer.

Fruits and Vegetables Against Cancer

Fruits and vegetables are important for good basic nutrition. They are naturally low in fat and contain a lot of fiber. A diet high in fiber may protect you against colon cancer. Fruits and vegetables also contain other important food components. They are excellent sources of vitamin C, carotenoids, and other plant compounds that are natural antioxidants. The antioxi- dants in plant food may play an important role in reducing your risk of cancer. Carotenoids are found in carrots, dark green leafy vegetables, sweet potatoes, tomatoes, papaya, cantaloupe, and broccoli. Vitamin C is found in citrus fruits such as oranges, and in cantaloupe, strawberries, peppers, broccoli, and tomatoes.

Scientists are continuing to study the other compounds found in fruits and vegetables to learn about the role those compounds may play in preventing cancer.

Whatever the reason, the evidence is strong that we should all eat five or more servings of fruits and vegetables every day to help us lower the risk of cancer.

Eat more fruits and vegetables - whether you eat them raw, frozen, canned, dried, or lightly cooked. When you cook vegetables, steam or microwave them to retain the vitamins and flavor.

Guide to Eating Well

Grains (breads, cereals, rice, pasta) form the foundation of a healthy diet. Serving sizes: 1 slice of bread, 1 oz. of cereal, 1/2 bagel, 1/2 cup of cooked pasta or rice.

Eat plenty of fruits and vegetables. Serving sizes: 3/4 cup fruit or vegetable juice; 1/2 cup raw, canned, or cooked fruits or vegetables, medium apple or banana, 1 cup raw leafy vegetables.

The Food Guide Pyramid (USDA)

Eat more fish, poultry, and dry cooked beans to reduce fat. Serving sizes: 2 - 3 oz. cooked lean meat, poultry, or fish, 1/2 cup cooked dried beans, 1 egg, 2 tbsp. peanut butter.

Choose nonfat or low-fat dairy products. Serving sizes: 1 cup milk or yogurt, 1 1/2 - 2 oz. low-fat cheese, 1/2 cup cottage cheese.

Eat foods from the top of the pyramid in moderation. Examples: cooking oil, butter or margarine, high-fat salty snacks, alcohol, candy.

Fiber

Fiber has no vitamins or minerals, yet it is important to good health. There are two types of fiber.

Insoluble fiber in whole-grain products provides bulk for your diet. Together with fluids, fiber stimulates the colon to keep waste moving out of the bowels. Without fiber, waste moves too slowly, increasing your risk for constipation, colon and bowel cancer, and diverticulosis.

Soluble fiber found in fruit, beans, peas and other legumes, and oats helps lower cholesterol, reducing your risk of heart disease. The fiber in legumes can also help regulate blood glucose and cholesterol levels.

Do you need more fiber? If your bowel movements are soft and easy to pass, you probably get plenty of fiber. If they are hard and difficult to pass, more fiber and water may help. See page 42 for more information on constipation.

To increase fiber in your diet:

Eat at least five servings of fruits and vegetables a day. Eat fruits with edible skins and seeds: kiwis, figs, blueberries, apples, and raspberries. Eat more of the stems of broccoli and asparagus.

Switch to whole-grain and whole-wheat breads, pasta, tortillas, and cereals. The first ingredient listed should be whole-wheat flour. If it just says wheat flour, it means white flour, from which much of the fiber has been removed.

Eat more cooked dried beans, peas, and lentils.

Popcorn is a good high-fiber snack. However, avoid added oil, butter, and salt.

Caffeine

There is no convincing evidence that a moderate amount of caffeine (two to three cups of coffee or cola per day) will do you any harm if you are healthy.

Caffeine is mildly addictive. Cutting back too quickly may cause a headache. Gradual reductions will prevent this.

Water

One easy way to improve your diet is to drink more water. Active people need two quarts of water a day.

People who exercise regularly need even more water. If you drink other fluids, you can get by with less, but plain water is best.

Sugar

What's wrong with sugar? It comes from a vegetable (sugar beets or sugar cane), is relatively cheap, tastes good, is fat free, and is even a carbohydrate. Can sugar be all that bad?

From a health point of view, the big- gest problem with sugar is that it is stripped of all vitamins, minerals, and fiber. What is left are crystals of pure calories.

In moderation, sugar does little harm. However, if too many of your calories come from sugar, you will either gain weight or not get enough of the other nutrients you need. Sugar also contributes to cavities.

Be aware of hidden sugars in flavored yogurt, canned, and other processed foods. Check the label for words that end in "-ose," like dextrose, fructose, sucrose, lactose, and maltose, which are forms of sugar. Corn syrup is another common form of sugar.
Limit foods that list sugar among the first few ingredients.
Look for breakfast cereals that have six grams or less of added sugar per serving.
You can reduce the sugar in home-made baked goods by up to one-half without affecting the texture.
Eat a sweet piece of fruit instead of a sugary dessert.
All sugars are basically alike. Honey and brown or raw sugar have no advantage over other sugars.

Artificial Sweeteners

Although artificial sweeteners do help you avoid sugar, weight-loss success depends more on reducing calories from fat. Avoid using artificially sweetened foods to justify eating more high-fat food.

Aspartame (NutraSweet) and saccharin are not considered to cause any health problems, but the effects of long-term use are not yet known. Use them in moderation.

Fats in Foods

Fat, butter, lard, cream, oil, margarine, mayonnaise, and grease in foods account for 37 percent of the calories in the average American diet. Fat has more than twice as many calories per gram as carbohydrates or protein.

How much fat is too much? The USDA Dietary Guidelines recom- mend that less than 30 percent of total calories come from fat. Changing from a diet that contains 37 percent fat to one that contains 30 percent fat may slow the development of heart disease, reduce cancer risk, and improve your overall diet. But is it enough?

Many scientists suggest a 30-percent fat diet is still too high for a healthy heart. A 20-percent fat diet will slow heart disease even more. There is some evidence that a 10-percent fat diet, along with other lifestyle changes, can even reverse the buildup of arteriosclerosis in the arteries. However, a 10-percent fat diet is challenging to maintain.

Based on your heart disease risks, you may wish to set a goal for how much fat to include in your diet. A nutritionist can help you with a menu plan to meet your goal.

The 80-20 Rule

If you are generally healthy, you don't need to worry about perfection in a healthy diet. If you make healthy eating choices 80 percent of the time, occasional high-fat or high-calorie foods won't be a prob- lem the other 20 percent of the time.

15 Simple Ways to Reduce Fat

When eating meat:

Eat more poultry and fish. Choose lean cuts of meat, such as tenderloin, top and bottom round, or lean veal.

Remove all visible fat before cooking. Poultry skin may be removed either before or after cooking.

Broil or bake instead of frying.

Reduce serving sizes to two or three ounces and don't take seconds.

Replace some meat with cooked dry beans and grains.

When using dairy products:

Use skim or 1% milk.

Choose low-fat, part skim milk cheeses like Gruyere, Farmer's, Jarlsberg Swiss, mozzarella, or ricotta. Look for low-fat or nonfat Cheddar and Monterey Jack cheeses.

Substitute low-fat or nonfat cottage cheese and yogurt for cream and sour cream, or use fat-free sour cream and cream cheese.

In cooking:

Steam vegetables, saute with one teaspoon of oil or less, or cook with wine or defatted broth.

Use non-stick pans or add oil to a preheated pan. Less oil goes further this way.

Flavor vegetables with herbs and spices instead of butter and sauces, or try Butter Buds or Molly McButter.

Experiment using less oil than is called for in recipes. You may need to increase other liquids. Use applesauce to replace some or all of the fat in baked goods.

In general:

Avoid crackers, chips, cookies, and margarines made with hydrogenated oil, palm oil, coconut oil, or cocoa butter.

Eat plenty of carbohydrates to fill you up (fruits, vegetables, grains, bread, pasta, etc.).

Let salads go naked, modestly dressed with lemon juice, or use fat-free dressings and mayonnaise.

Small Changes Can Make a Big Difference

You don't have to change your whole diet at once. Pick one easy change at first and stick with it. Add others once you've had success with the first change.

Buy only whole-grain bread.
Buy only skim or 1% milk.
Use less oil for cooking.
Eat fish at least twice a week.
Eat a raw vegetable at lunch.
Drink an extra glass of water when you wake each morning.

Cholesterol

Cholesterol is a waxy substance that is produced by the human body and is also found in animal products. Some cholesterol is needed for cells to function. Unfortunately, excess cholesterol builds up inside the arteries. Cholesterol deposits (arteriosclerosis) are the major cause of heart attacks and strokes.

The amount of cholesterol in your blood is a good predictor of your risk for heart disease and stroke, along with how much you smoke, how high your blood pressure is, your family medical history, and whether you have diabetes. The higher your cholesterol level, the higher the risk. However, not all cholesterol is bad.

Good Cholesterol

Fat travels through your bloodstream attached to protein in a combination called a lipoprotein. Two lipoproteins are the main carriers of cholesterol: low-density lipoprotein (LDL) and high-density lipoprotein (HDL).

LDL acts like a fat delivery truck. It picks up cholesterol from the liver and delivers it to the cells. When more cholesterol is ready for delivery than the cells can take, LDL cholesterol drops off the extra cholesterol on the artery walls. A lot of LDL cholesterol in your blood increases your risk of heart disease and stroke.

HDL works like a garbage truck. It removes excess cholesterol from the bloodstream and takes it to the liver. A lot of HDL cholesterol decreases your risk of heart disease and stroke.

Cholesterol Screening

It's a good idea to have your total cholesterol tested about every five years between ages 40 and 65. After age 65, high cholesterol no longer predicts heart disease risk very well. Cholesterol screening is recommended before age 40 if you have any of the following other risk factors for heart disease:

Family history of early heart attack (before age 55 in father or brother; before age 65 in mother or sister)

Current cigarette smoking

High blood pressure (over 140/90) or taking high blood pressure medication

Diabetes

Total Cholesterol Scores

Total cholesterol levels are categorrized as follows by the National Cholesterol Education Program:

Under 200 mg/dL: Desirable
200 - 239 mg/dL: Borderline high- risk
240 or higher: High-risk

However, overall heart disease risk depends on the combination of many factors, not just cholesterol levels. Although cholesterol levels often get the most attention, quitting cigarette smoking, increasing physical activity, and controlling your blood pressure may be even more important for some people than lowering cholesterol.

If your total cholesterol is high, measuring the other types of cholesterol (HDL and LDL) may be useful, especially before considering the use of medications to lower cholesterol. For most people, a low-fat diet is all that is necessary to lower cholesterol. Besides helping to lower cholesterol, a low-fat diet may help control diabetes, blood pressure, and may lower the risk of certain types of cancer.

Because of the potential side effects and risks, medication to lower cholesterol should only be considered in people at the highest risk for heart disease. If you are age 40 to 65, at very high risk for heart disease, and you find that a low-fat diet isn't enough to lower your cholesterol, then adding cholesterol-lowering medication may be helpful.

Calculating Percent Fat

Each gram of fat has 9 calories. To calculate the percent of a food's total calories that come from fat, multiply the grams of fat times 9 and then divide by the total number of calories. Multiply your result by 100 to get the percent.

For example, an 8-ounce serving of 2% milk has 5 grams of fat and 130 total calories:

(5 grams fat x 9 calories/gram)/130 calories = 34.6% calories from fat

The new food labels contain information about the percentage of your daily fat allotment in a serving of food.

For example, a food that has 6 grams of fat per serving provides 10 percent of the daily fat allotment in a 2,000 calorie diet.

Balance higher-fat foods with lower-fat vegetables, fruits, and grains.

How to Reduce Your Cholesterol

Eat less total fat. Because a high-fat diet increases cholesterol, just cutting back on cholesterol is not enough. You must cut back on total fats as well. See page 260.
Buy a cooking oil that is liquid at room temperature (such as canola, corn, soybean, sunflower, or cotton-seed oil) and use less of it.
Eat two to three servings of fish per week. Most fish contain omega-3 fatty acids that help lower blood cholesterol and triglycerides. In general, fish with darker flesh, such as mackerel, lake trout, herring, salmon, and halibut, have more omega-3 oils. The safety and value of fish-oil supplements is not yet known.
Exercise more. Exercise increases your protective HDL cholesterol level.
Quit smoking. Quitting can increase your HDL levels and reduce your risk of heart disease.
Lose extra pounds. Losing even 5 to 10 pounds can increase HDL levels and lower your total cholesterol.
Eat more soluble fiber, which lowers overall cholesterol. See page 258.
Attend a low-fat eating workshop, consult a registered dietitian, or read Resource 61 on page 310 to learn ways to lower your fat intake to 30 percent, 20 percent, or less of total calories, based on your goal.

Reversing Heart Disease

A low-fat diet and lifestyle changes may actually reverse the process of heart disease and help reopen arteries that are clogged by arteriosclerosis.

Participants in the Lifestyle Heart Trial followed a vegetarian diet containing less than 10 percent of calories from fat and no caffeine. They also stopped smoking, got 30 minutes of exercise at least six days a week, and practiced a relaxation technique (deep breathing, stretching, progressive muscle relaxation, etc.) for one hour each day. After a year, over 80 percent of the participants had lost weight, reduced their cholesterol, and most importantly, reduced the amount of blockage in their coronary arteries.

For more information, see Resource 40 on page 309.

Protein

Protein is important for maintaining healthy muscles, tendons, bones, skin, hair, blood, and internal organs. Most adult Americans get all the protein they need.

Protein deficiencies are rare. If you eat animal products (milk, cheese, eggs, fish, meat), your diet will contain plenty of protein. Even if you do not eat any animal products (vegans), if your diet includes a wide variety of vegetables, legumes, fruits, and breads and cereals, you will get all the protein you need.

Vitamins

Vitamins are exciting! These tiny, unseen elements of food have no calories, yet are essential to good health.

Vitamins A, D, E, and K are fat-soluble and can be stored in the liver or fat tissue for a relatively long time. The other nine are water-soluble and can be retained by the body for only short periods. They include:

Thiamine

Riboflavin

Niacin

Pantothenic acid

Biotin

Folate (folic acid)

vitamin B6

vitamin B12

Vitamin C

For most people, a diet that contains a variety of foods from the Food Guide Pyramid provides all the vitamins needed for good health.

If you eat less than 1500 calories per day, consider a low-dose vitamin/ mineral supplement.

Minerals

Minerals help regulate the body's water balance, hormones, enzymes, vitamins, and fluids. The various minerals must be maintained in delicate balance to ensure proper functioning of the systems they serve. Eating a variety of foods is the best way to get all the minerals you need.

Sodium

Most people get far more sodium than they need. Our bodies need only 500 mg of sodium per day. Anything over 2500 mg of sodium per day is probably too much.

For many people, eating less sodium can reduce their chance of developing high blood pressure. See page 36.

Salt is the most familiar source of sodium. About 40 percent of salt is pure sodium. Sodium is also hidden in foods that don't taste salty, such as cheddar cheese and processed foods. Sodium is also a major ingredient of monosodium glutamate (MSG), disodium phosphate, and baking powder.

If you want to cut back on the sodium in your diet:

Beware of ready-mixed sauces and seasonings, frozen dinners, canned soups, and salad dressings, which are usually packed with sodium. Products labelled "low sodium" con- tain less than 140 mg of sodium per serving.

Eat lots of fresh or frozen fruits and vegetables. These foods have very little sodium.

Don't put the salt shaker on the table or get a shaker that lets very little salt come out. Or, use Lite Salt or salt substitute sparingly.

Always measure the salt in recipes and use half of what is called for.

Creative Salt Substitute

Mix together and put in a shaker:

1/2 teaspoon cayenne pepper

1/2 teaspoon garlic powder

1 teaspoon each:

Basil
Black pepper
Mace
Marjoram
Onion powder
Parsley
Sage
Savory
Thyme

Iron

Small amounts of iron are needed to make hemoglobin, which carries oxygen in the blood. Adults need about 10 to 15 mg of iron per day. People who have increased blood loss from ulcers or heavy menstrual periods, or who regularly take aspirin, blood thinners (anticoagulants), or arthritis medications may need more iron. An inexpensive blood test can deter- mine if you need additional iron.

For more iron in your blood:

Vitamin C helps you absorb more iron from food. Drink a glass of orange or other citrus juice and eat a bowl of iron-enriched cereal. High-iron cereals have at least 25 percent of the USRDA or Daily Value of iron.
Increase absorption of vegetable iron by eating meat, poultry, or fish along with the vegetables. The iron in animal tissue improves the absorption of the iron in vegetables.

Iron Supplements

People who eat less than 1500 calories per day may wish to consider a multivitamin/mineral supplement that contains iron. A low-dose ferrous-form iron supplement containing no more than 20 mg is safe for most people. However, too much iron can cause a number of serious medical problems or mask the development of medical problems. Do not take more than 20 mg without consulting your doctor. Take the supplement with orange or other citrus juice. Keep iron supplements away from children.

Iron Deficiency Anemia

Chronic blood loss of any kind depletes the body's store of iron. Symptoms of iron deficiency anemia include paleness and fatigue. A blood test is needed to confirm the diagnosis because anemia can be caused by many other things.

Vitamin/Mineral Supplement Buyer's Guide

Although research is showing that vitamins from food intake may help prevent some diseases, it remains unproven whether supplements do the same. However, if you choose to take vitamin and mineral supplements, the following guidelines may be helpful:

Choose a balanced, multiple-vitamin/mineral supplement rather than a specific vitamin or mineral, unless it has been pre- scribed by a doctor. Too much of any one vitamin or mineral might be toxic and can interfere with the body's ability to use other vitamins and minerals.

Choose a supplement that provides about 100 percent of the RDA (Recommended Dietary Allowances) for vitamins and minerals.

Avoid taking much more than 100 percent of the RDA for any vitamin or mineral. This is particularly important for the fat-soluble vitamins A, D, E, and K and minerals. Because they are stored in the body, large doses can build up to toxic levels.

Don't use a supplement to make up for a poor diet.

High-priced brand-name vitamins or those sold door-to-door are no better than store or generic brands.

Check expiration dates.

A Healthy Weight

People come in all shapes and sizes. Genetics, exercise, and the food you eat all play a role in determining your body's shape and size.

Focus on Health, Not Weight

Eating well, enjoying physical activity, and accepting your body size are the keys to good health. Although excess body fat does increase your risks of heart disease, diabetes, and stroke, it is more important to focus on healthy habits rather than trying to achieve a certain body size or shape.

When you eat healthy, lower-fat foods and add more regular physical activity to your life, you may lose some weight, but more importantly, you will have some health habits that you can maintain for life.

Exercise Makes It Easier

Regular exercise makes you feel stronger, more energetic, and in better overall health. As a bonus, regular exercise makes maintaining a healthy weight a little easier.

Even short periods of exercise, done every day or every other day, can make a big difference. Pick an exercise you enjoy enough to stick with for a long time. Even a five-minute walk every day is a good start. Add more exercise when you can.

Exercise Keeps You Strong

Exercise helps build your lean muscle mass when you are losing weight. One of the biggest problems with "diets" is that if you don't exercise while you diet, you will lose both fat and lean muscle mass. Dieting in gen- eral has not been shown to be healthful, and dieting without exercise can be detrimental. Dieters often suffer from weakness and low energy. If you are trying to lose weight, include a regular exercise program.

Never Go Hungry

You may think that skipping a meal is a good way to lose weight. It is not. Going hungry, even for a few hours, can cause your metabolic rate to drop and make you more likely to overeat later. Take time to savor your food and relax during meals.

Focus on Fat, Not Calories

Eat a variety of nutritious, low-fat foods. Focus on eating more fruits and vegetables and on eating less fat, rather than counting calories. See the ways to reduce fat on page 260.

Get Help From Your Friends

The food customs and habits of friends and family affect what you eat. Ask friends and family to:

Encourage you to respect yourself regardless of what you weigh.
Celebrate events with a variety of nutritious foods and/or activities that everyone can enJoy.
Serve low-fat options with meals, and make water and low-fat snacks available.
Offer small servings, and don't insist on second helpings.
Join you in a walk, swim, or other enjoyable activity.

Help Yourself to Good Thoughts

Develop a positive affitude about yourself. Think of yourself as healthy, and take pride in making positive nutrition and exercise choices. Focus on living a healthy life regardless of your weight.