How to Eat Smarter
In a world that is raining food, making healthy choices about what and how to eat is not easy. Here are some rules to live by
By CHRISTINE GORMAN
Saturday, Oct. 11, 2003
It's 6:45 p.m. after a bruising day at the office and a hair-raising commute on the freeway, you are standing in the kitchen about to prepare a healthy, satisfying dinner for your spouse, your two school-age children and yourself. As usual, all they want to know is "What's for dinner?" and "When do we eat?" You dump a box of thin spaghetti into a pot of boiling water, zap 3 cups of green beans in the microwave, pop a loaf of frozen garlic bread into the toaster oven and pour a medium-size jar of marinara sauce into a saucepan to simmer. While all that's bubbling, you chop up half a head of iceberg lettuce and a couple of tomatoes for the salad, which you'll sprinkle with a light dressing. Dessert will be two scoops of frozen yogurt per person and a plate of assorted low-fat cookies for the family to share. Sounds pretty healthy, right?
Wrong. While this meal may be better than what most Americans eat for dinner, it's enough food for a family twice the size of yours. In addition, it contains some nutritional traps that in the best-case scenario will make you fat and in the worst will increase your chances of developing diabetes, heart disease and certain types of cancer. Think you know the pitfalls? Read on. You may discover some surprises.
Here are just a few of the problems:
Most "light" salad dressings are too heavy on sugar and salt and too light on nutrition. A better choice is a simple oil-and-vinegar dressing, which—although packed with calories—contains lots of heart-healthy mono-unsaturated fatty acids and no saturated fat.
You're serving your family too many highly processed foods. The latest research shows that such foods won't keep them satisfied for very long and may make them hungrier in the long run.
Having different kinds of cookies to choose from makes it more likely that your family will eat more cookies than they should. The fewer our choices, the less we eat.
Your portion sizes are far too generous. According to the U.S. Food Guide Pyramid, you're giving each member of your family 4 servings of spaghetti, 112 servings of marinara sauce and 2 servings of frozen yogurt. The whole meal contains 1,500 calories per person, or 80% of the daily requirement for a sedentary office worker.
Let's not even get started on whether the tomatoes should be cooked or raw, how much salt, sugar and trans fat there is in the garlic bread, or how many calories are packed into that marinara sauce. It just goes to show that it's hard to eat healthy even when we try. We've all heard that fruits and vegetables are good for us, that restaurant portions are too big, that we should exercise more. But even a casual glance at public-health statistics suggests that Americans don't know how to put that information into practice. Two out of three Americans are overweight or obese. The incidence of Type 2 diabetes among children is climbing. And any gains we've made against heart disease by quitting smoking may be about to disappear. Alarmed by the worsening trends, health experts have unleashed a flood of nutritional advice for consumers—much of it contradictory. One expert says red meat is bad. Another says bacon keeps you trim. Someone says skip the potatoes, and someone else says eat the skin. And let's face it, controversy sells. Diet books and magazine articles try to grab our attention by telling us everything we thought we knew was wrong. (It's not.)
Even the government-approved labels on our food can lead us astray. Serving sizes bear no relationship to the helpings we usually eat. Low-fat products are not necessarily low in calories. And now the Food and Drug Administration says we should be on the lookout for trans fat—a lesser-known type of fat that is every bit as bad for the heart as saturated fat—though we won't learn which products are the worst offenders until 2006. Meanwhile, the food pyramid, which serves as the basis for all meals prepared in the federal school-lunch program, is about to be changed. However, the next revision won't be out until 2005.
"People can feel like a ping-pong ball," says Dr. David Katz, head of the Yale School of Medicine Prevention Research Center and author of The Way to Eat (Sourcebooks; 2002). "They are being batted in one direction and then another." Not that we necessarily mind. Being perplexed can ease our conscience. As long as we can point to a general state of nutritional confusion, we don't have to take responsibility for our ever expanding waistlines.
The truth is that nutritionists have a fairly good idea about what constitutes a healthy diet as well as plenty of solid evidence to back that up. As a rule, they tell us, we should eat lots of fruits and vegetables, favor whole grains over highly processed cereals and make red meat an occasional treat rather than the daily centerpiece of our evening meal. And we shouldn't eat any more than our body needs.
The problem is that no matter how much we think we know about what goes into a healthy meal, we often misjudge the results. Some vegetable dishes, it turns out, are healthier than others, some grain products are less processed than others, some fish are safer than others. You may think you are eating right, but by making subtle changes in what you eat and how you eat it, you could start eating considerably healthier.
The rewards are worth the effort. Studies show that as much as 80% of heart disease and 90% of diabetes can be tied to unhealthy eating and lifestyle habits. Doctors have proved that a diet emphasizing fruits and vegetables as well as small amounts of nuts and dairy products can lower blood pressure and "bad" cholesterol as effectively as many medications. And evidence is growing that adding fiber to your diet and avoiding highly refined foods can help prevent or delay the onset of Type 2 diabetes.
You don't have to sacrifice flavor. You don't have to go hungry. "It doesn't have to be an all-or-nothing thing," says Dr. Donald Hensrud of the Mayo Clinic in Rochester, Minn. "That attitude can actually make it harder." You do need to put in some effort—much of it in the kitchen—and accept that there really is no free lunch. But with a little planning and a better understanding of some of the basic food traps, we can all eat a whole lot better and smarter.
You need Less Food Than You Think "Everything in moderation" is a great motto until you realize that moderate means different things to different people. Better to nail down some specifics and measure them using a tough-to-fudge yardstick—the much dreaded but ultimately very helpful concept of the calorie. Stop, don't turn the page just yet. We're not going to get tediously obsessive about this. But whether you, like most Americans, need to lose weight or you just want to maintain the figure you already have, you've got to know a little something about calories.
At its heart, the rule for losing weight is simple: eat fewer calories than you burn. As anyone who has ever tried to shed a couple of pounds knows all too well, that's often harder than it sounds. Eat too little, and your body ratchets down its metabolism so that it doesn't need as much energy and you regain weight more easily. One way to counteract that is to boost your level of physical activity to increase the number of calories you burn.
But when it comes to weight control, exercise—though necessary—can take you only so far. Think about it, and you'll understand why. Food is so plentiful and so readily available that you're always going to be able to eat more than you can sweat off. The average American consumes 530 calories more per day now than he or she did in 1970. That's roughly what you'd get from eating 21/2 cups of cooked pasta. You would have to walk an extra two hours a day to burn that off. That doesn't mean you should forget about exercising—the benefits to your heart, bones and peace of mind are just too great. It does mean you have to pay more attention to the "calories in" side of the equation.
Few of us really get this message. "People don't understand the most basic things about calories," says Marion Nestle, chair of the department of nutrition, food studies and public health at New York University. "Larger portions have more calories. Eating more often means that you eat more calories. Having food in front of you means you eat more calories."
Even if you're happy when you step on the scales, you can't eat the way you did when you were a teenager—or even just a decade ago. As you grow older, your body needs fewer calories to keep going. Certain exercises—like yoga or weight training—help counteract the trend because they build muscle, which burns more calories than fat. But at some point, to avoid gaining weight, you will have to eat less.
The Secrets of Portion Control So, what are some smart ways of cutting back? Start by fooling both your eyes and your stomach. As you reduce the amount of food you eat, use smaller plates to keep your meals from looking skimpy. Begin a couple of meals each week with an apple or a cup of soup. Either will help curb your appetite. The apple, besides being nutritious and only 80 calories, is full of soluble fiber, which keeps the stomach from emptying too quickly. And there is something about the texture and consistency of soup (broth-, not cream-based, low in sodium and not more than 150 calories) that is particularly satisfying to the stomach. Several intriguing studies have found that other liquids, like fruit juices or sodas—which are often high in calories—do nothing to suppress the appetite.
Watch out for the portion-size trap. For reasons known only to bureaucrats, the portion sizes provided in the U.S. government's food pyramid can differ dramatically from those indicated on a product's food label. (One set of figures is regulated by the Department of Agriculture, and the other, which appears on product labels, is regulated by the Food and Drug Administration.) A single serving of pasta is 12 cup (cooked) according to the usda, 1 cup according to the FDA and at least 2 cups according to most families.
Eat a variety of fruits and vegetables, but limit your choices of everything else, particularly snacks. Giving folks a wide choice of foods in a single meal, scientists have shown, encourages them to eat more. "It works for every species ever tested—humans, rats, fish, cats," says Susan Roberts, professor of nutrition at Tufts University in Boston. If there are two types of cookies on a plate, the temptation is to eat one of each.
Eventually, you will have to become familiar with the calorie count of your foods. Just a couple of days of measuring or weighing what you eat and calculating the calories you consume can be a real eye-opener. You don't have to do this for the rest of your life, just long enough to get a feel for it. Many nutritionists recommend eating healthy frozen dinners, whose calorie counts are printed on the package, as a good way to make the transition to smaller portion sizes. How many calories you should eat in a day depends on whether you want to lose or maintain weight. The American Heart Association's rule of thumb is to multiply your weight in pounds by 13 (15 if you're active). If you want to lose weight, subtract 250 calories.
All Fats Are Not Created Equal for more than 30 years, most researchers agreed that the healthiest diets were those low in percentage of calories attributable to fat. Now they realize that just as there are good and bad types of cholesterol, there are good and bad types of fat. The good fats—found in foods like fish, olive oil, avocados and walnuts—actually improve cholesterol levels in the blood and significantly reduce the risk that the heart will suddenly stop. As for the bad fats, there are now two villains instead of just one. Saturated fats—typically found in red meat, butter and ice cream—are still champion artery cloggers. But trans fats—found primarily in processed foods, such as margarines and many commercially baked or fried foods but also in whole milk—may be even worse.
Good fats do more than help protect the heart. They also seem to delay hunger pangs. "People on these high-starch, low-fat diets are often hungry soon after they eat. They would be more satisfied eating nuts or a salad with a full-fat dressing," says Dr. Walter Willett, chairman of the department of nutrition at the Harvard School of Public Health and author of Eat, Drink and Be Healthy (Fireside; 2001). "And longer-term studies are showing that people tend to be able to control their weight better over the long run on a moderate or higher-fat diet than on a low-fat diet."
Fats have more flavor—a fact that was not lost on the editors of Cooking Light magazine. Since the mid-1990s, they have slipped a modicum of butter into their recipes. "You have to make food enjoyable," says Jill G. Melton, senior editor of Cooking Light (which, like TIME, is owned by AOL Time Warner). "If something tastes bad, you're not going to want it again."
Just remember that there's a smart way to include fat in your diet and lots of unhealthy ones. Good fats contain double the calories (9 calories per gram) of either proteins or carbohydrates (4 calories per gram). So there's little room for error. If you eat nuts, you're going to have to eat less of something else.
What about the Mediterranean diet? you ask. Researchers have long been fascinated by the traditional Greek and Italian diets of the 1960s, which contained as much as 40% fat but didn't trigger a lot of heart attacks. Don't assume that what worked for Greeks and Italians 40 years ago will work for you. After all, they typically ate a pound of fruit a day (equal to four medium apples) and little red meat, and many of them got lots of exercise tilling fields and tending livestock. "The Mediterranean diet works well in the Mediterranean," says Yale's Katz. "My concern about it in the U.S. is that people will continue to go to Burger King but just dump olive oil over their French fries."
You can go overboard trying to avoid trans fat. Yes, there is a small amount of trans fat in whole milk, but whole milk is what most pediatricians recommend for children from the age of 1 to 2. Their brains need all kinds of fats to develop properly. After they reach age 2, you've got to be on the lookout for saturated fats as well. "You don't want people to think trans fats are the only bad guys," says Alice Lichtenstein, a nutrition professor at Tufts University in Boston and a frequent spokeswoman for the American Heart Association. "If a cracker has 2% trans and 2% saturated fat, it's better than 7% saturated and 0% trans." Finally, no matter how low McDonald's reduces the amount of trans fat in its French fries, they are never going to be a health food. Which brings us to ...
The Potato Factor It's not that spuds are so bad; it's that they're misunderstood—not to mention deep-fried and drowned in sour cream and cheese. America's much beloved tuber definitely has a dual personality. A good source of potassium (particularly if you eat the skin) and a great thickener for soups, the potato still doesn't have all the benefits bestowed by more colorful produce like broccoli, Brussels sprouts and green beans. v This problem of mistaken identity extends to quite a few of the foods we commonly call carbohydrates. First, a tiny rant about the word carbohydrate. When nutritionists first advised us to replace some of the fats in our diets with complex carbohydrates, what they had in mind was beans, fruits, leafy green vegetables and whole grains. What we loaded up on was pasta, white rice and French fries. Technically, we were following the rules, but by focusing on these highly processed or refined foods, we were missing out on a lot of antioxidants and other important nutrients. And we found out, much to the detriment of our waistlines, that it's a whole lot easier to overeat pasta, rice and potatoes than apples and broccoli.
O.K., so maybe the experts were a little naive about human nature. But no one anticipated the enthusiasm with which the food industry would jump on the low-fat bandwagon. Alas, it mostly just replaced the fat with refined foods and sugars and left consumers with the impression that they could eat as much of this stuff as they wanted. As if that weren't bad enough, it is becoming increasingly clear that some folks respond to highly refined foods differently than the rest of the population. All carbohydrates get broken down in the body into a simple sugar called glucose. This is a good thing, since glucose is the principal fuel that powers our bodies and brains. But about a quarter of American adults—some 50 million men and women—have trouble regulating their glucose levels. The hallmarks of this condition, which nutritionists now call metabolic syndrome, include a big waist (40 in. or more for men; 35 in. or more for women), high blood pressure (more than 130/85 mm Hg), a predisposition toward diabetes and troubling cholesterol levels in the blood.
Doctors aren't quite sure exactly why the body sometimes reacts this way, though they know that metabolic syndrome is exacerbated by a sedentary lifestyle. Hence their No. 1 recommendation for patients with metabolic syndrome is to get more exercise and build muscle mass. But they also now advise them to replace at least some of the refined carbohydrates in their diets with healthy fats, like those in nuts and olive oil. In 2000 the American Heart Association, which has long touted the advantages of a low-fat lifestyle, added an exception to its guidelines for folks with this condition.
None of this means you should avoid eating fruits and vegetables. (In their natural form, they are not highly refined.) Just make sure that they are as colorful as possible—in order to get a wide variety of nutrients and those ever important antioxidants. Using spinach instead of iceberg lettuce in a salad, for example, will double the dietary fiber consumed, more than quadruple the calcium and potassium, more than triple the folate and provide seven times as much vitamin C. If you don't like spinach, try a more nutritious lettuce like romaine or Boston.
Your goal should be to eat at least five 12-cup servings of fruits and vegetables a day—and preferably more. (Nine is divine, according to the latest nutritional research.) Don't assume that fresh is the only game in town. "Frozen can be just as good and occasionally better," says Lichtenstein at Tufts. Because frozen fruits and vegetables are chilled immediately after being picked, they often contain more nutrients than produce that has been sitting on the shelf.
Sirloin, Salmon or Beans? Protein from any number of sources can be part of a healthy diet. But figuring out just how much or how little of each to include can be tricky. We've known for some time that most Americans need to cut back on their consumption of red meat because of its high saturated-fat content. But now some health experts are raising the possibility that eating too much fish—long a staple of heart-healthy diets—may expose folks to dangerous levels of mercury and other poisons. That's still being debated. A study published in August suggests that most of the mercury found in fish is of a form that is not particularly toxic to humans. So if your choice is between the third helping of swordfish that week and a Big Mac, go for the swordfish.
Overall, how much protein do you need? Given the popularity of high-protein diets, you may be surprised to learn that there hasn't been much research on the long-term health benefits and risks of eating lots of protein, though there is concern that too much protein can lead to kidney and liver problems. Scientists have calculated the minimum amount needed to keep your muscles from breaking down—just under 70 grams, or about 212 oz., a day for someone who weighs 150 lbs. (Food is so plentiful that Americans rarely develop protein deficiencies.) Whether high levels of protein are linked to an increased risk of developing cancer or heart disease remains unclear. What is known is that too much protein of any kind can leach calcium out of your body and that eating lots of animal protein usually means you're increasing your intake of saturated fat as well. "I don't believe any nutritionist would argue that 30% protein isn't a reasonable upper limit for long-term safety," says Roberts at Tufts. But what is safe and what is ideal are two different matters. Current federal guidelines suggest that adults get 10% to 15% of their daily calories from protein. If you're like most people, what interests you about high-protein diets is the possibility that they might make it easier to slim down. Preliminary evidence suggests this may be the case over the short run, but in many ways, that is almost beside the point. "People forget they should be eating a nutritious, healthy diet for other reasons," says Barbara Rolls, professor of nutrition at Pennsylvania State University. "They go on these kooky weight-management fad diets, and they lose all sight of bone and cardiovascular health." So remember, a little protein goes a long way. Your muscles will not fall apart if you don't eat protein at every meal. Stick with leaner cuts of meat and give preference to beans, fish, chicken or pork over red meat.
The basic rules for eating smarter couldn't be simpler. Watch your total calorie intake. Burn off as many calories as you take in. And be choosy about the foods you eat—not just for a couple of weeks or months but for the rest of your life. "It takes work," says Dr. John Swartzberg, who chairs the editorial board of the U.C. Berkeley Wellness Letter. "We live in a fast-food world." The sooner we accept that that is not the healthiest of environments for us, the better off we'll be.
So, what's for dinner? — Reported by David Bjerklie and Amanda Bower/New York, Laura Locke/San Francisco, Maggie Sieger/Chicago, Frank Sikora/Birmingham and Cathy Booth Thomas/Dallas