For Healthy Eating, Do You Focus on Big Picture or Details?

How do you move from a vague goal of healthy eating to actionable steps you can take?

Have you heard the expression, “The devil is in the details”? It’s a way of saying that the little details of how we do something can make a big difference in outcome. But what about the idea that sometimes “you can’t see the forest for the trees”? That’s referring to how easy it is to be so focused on details that you miss seeing the impact that comes from how the little things all fit together.

For me, the answer for eating choices that support health is not which view is better. It’s about how to go back and forth, holding both views in balance. As you think about this balance and the choices you make for a healthy lifestyle, here are a few recent studies you might find helpful.

The Big Picture of Healthy Eating

To study overall eating patterns’ influence on health, researchers often use one of several scoring systems to rate how close people’s eating habits come to a set of dietary recommendations. For example, scoring systems have been created to represent how well people’s typical eating choices meet the federal Dietary Guidelines for Americans, the principles of the Mediterranean diet, and the DASH diet (Dietary Alternatives to Stop Hypertension, now shown to promote a lot more than healthy blood pressure). Each of these come in different versions, reflecting changes in the federal guidelines published in 2005 versus 2010, and attempts by researchers to distill down the essential components that make a Mediterranean or DASH diet healthful.

In all cases, however, these diet scores represent the sum of eating choices. No matter how well you do on choosing lean meat, you can’t completely make up for too much sodium or too few vegetables, for example.

Higher Diet Quality Is Associated with Decreased Risk of All-Cause, Cardiovascular Disease, and Cancer Mortality among Older Adults, published in the June 2014 Journal of Nutrition, looks at four different indices of healthy eating. People from the NIH-AARP study, ages 50 to 71 at the start of the study, were followed for 15 years.

The results show that highest scores on any of the four assessments of healthy eating were linked with less chance of dying over the ensuing years. This included 14 to 28 percent fewer deaths due to heart disease and 12 to 26 percent fewer deaths due to cancer. Importantly, these links are what we see after researchers adjusted for physical activity, weight (as body mass index, or BMI), presence of diabetes, and background demographic differences (like age and ethnicity). Since one of the ways that eating habits influence risk of cancer is through help in reaching and maintaining a healthy weight, this aligns with research reports from the American Institute for Cancer Research (AICR) and others citing the cancer risk of excess body fat, while saying there’s more to it than that.

A new study was just reported at the American Diabetes Association Scientific Sessions, the organization’s major research update conference. Researchers used one of the same diet scoring systems used in the Journal of Nutrition study above to investigate how healthy eating habits might link to risk of developing diabetes. As you can see in this video summary, people who improved their healthy eating scores by 10 percent over four years reduced their risk of type 2 diabetes by about 20 percent, compared to people who did not change their eating habits. Examples of point-earning changes include eating more whole grains, fruits and vegetables, and less sweetened beverages and saturated fats. Definitely worth noting, this lower risk was independent of change in weight or physical activity, choices which can also help lower type 2 diabetes risk. The study has not yet been through peer review or published, so we’ll need to wait to learn more. However, these results are in line with findings of other studies.

So here’s the big picture view: regardless of exactly how you define it, the same core tenets are represented in these scoring systems, linking an overall healthy eating pattern as one that is focused around nutritious plant foods — whole grains, vegetables, fruit, and plant sources of protein like beans.

What about the Details of Healthy Eating Choices?

Mounting research suggests that health is more strongly tied to our overall eating pattern than to whether we get enough of any individual nutrients, or keep those linked with poor health low enough. On the other hand, our overall eating pattern is made up of the collection of many choices we make all day long about what and how much we eat and drink.

So in that sense, the little choices – each one a habit you can work on – are what add up to make a difference. For example, beyond the importance of including plenty of vegetables and fruits in all your meals, choosing a wide variety can provide a wider array of protective nutrients and phytochemicals (natural plant compounds). One recent paper published by the Centers for Disease Control and Prevention (CDC) aimed to rank “Powerhouse Fruits and Vegetables” by creating a score based on the percent of recommended intake of 17 nutrients supplied in relation to calorie content. These 17 include some that tend to be low in the U.S. diet and for which vegetables and fruits are important sources.

However, the score also includes nutrients, like some of the B vitamins, that are not particular problem nutrients for most Americans, and some, like Vitamin D, which we mostly get from foods other than vegetable and fruit choices. What’s more, because comparable data for phytochemical content is lacking, this was not reflected in the powerhouse rankings. Since research continues to emerge showing multiple potential roles these phytochemicals may play in promoting health, I find it hard to consider the fruits and vegetables that achieved top ranking due to high content of vitamins A, C and folate as necessarily more worthy of emphasizing in my eating habits than some for which phytochemical content is especially high. Here’s a commentary from the AICR blog.

I agree that the CDC paper is helpful for suggesting some new additions you might try to broaden the variety of vegetables and fruits you eat, but I would not use the rankings to suggest swapping out phytochemical-rich choices that didn’t make this list. In previous Smart Bytes® posts we’ve looked at why ORAC antioxidant scores are also not solid ground for rating vegetable and fruit choices. A simple goal: make vegetable and fruits a big part of every meal, and learn to enjoy a wide variety.

Lifestyle in the Big Picture

As you look at the big picture view, remember that healthy eating habits are only one part of a lifestyle that supports good health. Several recent studies add more support for the importance of lifestyle choices beyond the long-established habits of avoiding tobacco, getting some form of physical activity every day, and maintaining a healthy weight.

Getting enough sleep? Several studies that followed people for ten to twenty years link getting less than six or seven hours of sleep a night with greater likelihood of weight gain. In one recent study, sleep deprivation produced changes in brain activity in the “reward center”, which could explain links between lack of sleep and preference for sweets and other high-calorie foods. If too little sleep leaves you too tired to be physically active, or more likely to turn to sweets and other foods to perk up your energy, it could increase the calories you consume and decrease calories burned, leading to weight gain or counteracting your efforts to lose weight. On a practical basis, if you stay up late, more time awake means more time available for eating. Between six and eight hours of sleep each night seems to be the “sweet spot” for most people based on current studies.

Sit much? Restful sleep is good, but too much sitting seems harmful to your health. Initially it wasn’t clear whether the links of extended sitting time to risk of chronic disease really related to not getting recommended amounts of physical activity. Studies now suggest that even if you get the recommended 30 to 60 minutes of moderate activity recommended to lower risk of cancer and promote overall health and weight control, too much sitting is just not healthy, especially if you’re sitting for extended periods.

A new study in the Journal of the National Cancer Institute combines many studies and analyzes them together. Results link increased risk of colon and endometrial cancers to more time spent sitting each day, and the link was doubly strong for extended time watching television. A previously published analysis of four studies ties every two hours spent watching television with a 20 percent increased risk of developing type 2 diabetes.

I guess the bottom line is that if you’re tired, get more sleep instead of staying up bleary-eyed watching TV or surfing the Internet.

When you are surfing the Internet, I hope you’ll be back soon for another edition of Smart Bytes®!

Meanwhile, if you enjoyed this post, please share it on social media, or email a link to someone you think would enjoy it, too.

Studies of Interest

Reedy J et al. Higher Diet Quality Is Associated with Decreased Risk of All-Cause, Cardiovascular Disease, and Cancer Mortality among Older Adults. J Nutr 2014;144(6):881-889.

Di Noia J. Defining Powerhouse Fruits and Vegetables: A Nutrient Density Approach. Prev Chronic Dis 2014; 11:130390.

St.-Onge, M-P et al.  Sleep restriction increases the neuronal response to unhealthy food in normal-weight individuals. Int J Obesity 2014; 38:411.

Yang L and Colditz G. Active Lifestyle for Cancer Prevention. An Active Lifestyle for Cancer Prevention. (Editorial) JNCI J Natl Cancer Inst 2014; 106(7): dju135

Grøntved A and Hu FB. Television Viewing and Risk of Type 2 Diabetes, Cardiovascular Disease, and All-Cause Mortality: A Meta-analysis. JAMA 2011; 305(23):2448-2455.