How do you set priorities to assure that your “healthy choices” are doing the most good for health and vitality?
A look at several studies making headlines in the last few weeks shows that the answer may not be as clear-cut as it seems.
Let’s pull them together for a look at the big picture.
Ten Nutrition Priorities?
Unhealthy eating, defined based on 10 specific eating habits, links to nearly 1,000 deaths a day from heart disease, stroke, or diabetes, says Dariush Mozaffarian, MD, DrPH. He was at an American Heart Association research conference I attended, presenting results from a recent study published in JAMA that’s garnered quite a few headlines.
Researchers selected 10 factors with strong evidence as causes of heart disease, stroke, high blood pressure or diabetes. Applying statistical analysis to a large survey of U.S. eating habits, they then identified how unhealthy amounts (too little of healthful foods, too much of foods linked with poor health) relate to U.S. deaths. Excess sodium was the top culprit in this analysis, followed by low intake of nuts and seeds, high intake of processed meats (such as bacon and sausage), low seafood omega-3 fats, low vegetables, low fruits, high sugar-sweetened beverages, low whole grains, low polyunsaturated fats, and high unprocessed red meats (beef, lamb, pork).
At the same conference, a study looking only at deaths due to heart disease and stroke identified strongest links to low consumption of nuts, vegetables and whole grains; and excess dietary sodium. Similar to the JAMA study, other top links were: low fruit, fiber, omega-3 fat, and polyunsaturated fats; and high trans fat (found in hydrogenated shortenings used in a variety of bakery, snacks and processed foods), processed meats, and sugar-sweetened drinks.
- Even though each individual element of our eating habits may play a small role in disease, our daily choices come together to play a substantial role. This type of study can only show these specific eating habits as links to, not causes of, deaths from heart disease and diabetes. Although analysis adjusted for other factors that could play a role, it’s possible that additional diet or lifestyle choices play a part in the picture, too.
- The ranking of these eating habits refers to the strength of their association in the whole population, yet it was not the same for everyone. People who had especially unhealthy amounts of particular foods tended to show a stronger link for those foods. (For example, groups who ate the most processed meat showed more deaths linked to them than the population as a whole.)
- Low consumption of healthful foods was related to at least as many deaths as excess amounts of unhealthful foods. That’s important as you think about creating healthy eating habits – beyond cutting back on foods like regular soda, hot dogs, pepperoni, and high-sodium convenience foods, it does matter what you eat instead. Compare your typical daily eating with criteria the researchers of the JAMA study used to define “optimal”:
- Vegetables – including dried beans and peas – at least 400 gm/day (which is about 2 ½ cups, with each cup of raw leafy greens counting as ½ cup)
- Fruit – not counting juice – at least 300 gm/day (which is about 2 medium pieces of fruit or 2 cups)
- Whole grains – at least 125 gm-/day (total 5 or more of the following each day: 1 slice whole-grain bread; or ½ cup of whole-grain ready-to-eat cereal, cooked whole-grain pasta, brown rice, quinoa, or other cooked whole grain)
- Nuts and seeds – equivalent of at least five one-ounce servings per week
- Seafood-supplied omega-3 fats – at least 250 mg/day (available from 8 ounces of a variety of fish per week, or 4 ounces/week if it’s fish high in omega-3 fat)
Is Gluten-Free the Answer, or Does it Pose Risk?
With the current popularity of gluten-free diets, it’s not surprising that media headlines about this study have gotten a lot of traction. Unfortunately, the important point from the study’s findings may be missed.
It’s essential for people with celiac disease to avoid gluten-containing foods (those with any amount of wheat, rye or barley-based ingredients), and research is ongoing regarding other types of gluten sensitivities outside of celiac disease. However, avoiding gluten is also being advocated by some books and celebrities for “clean living” or weight loss. Avoiding some gluten-containing foods, like cookies and battered, deep-fried foods, can be a positive nutritional change. But a decision to go gluten-free should not be taken lightly, since gluten is found in many of our most common whole grain choices – which are recommended for multiple aspects of health.
American men and women from three large population studies were followed for over 20 years in a study presented by Harvard Research Fellow Geng Zong, PhD, at the March American Heart Association research conference. People with the highest gluten intake were 20% less likely to develop type 2 diabetes than people with the lowest gluten intake. Part of the link between higher gluten intake and lower risk of diabetes seems related to higher fiber in those diets. However, risk remained lower even after adjusting for fiber intake.
Perhaps this reflects health benefits from nutrients, lignans and other polyphenol plant compounds in whole grains. Moreover, dietary fiber and a carbohydrate called resistant starch serve as prebiotics, supporting health-promoting gut bacteria that may help fight inflammation and reduce risk of type 2 diabetes and obesity.
This study also calls into question claims sometimes heard about gluten as a cause of weight gain. Not only would gluten-related weight gain likely increase risk of type 2 diabetes – rather than the decreased risk seen here; looking specifically at change in weight over four years found no relationship to gluten intake.
- Given the links between whole grains and fewer deaths from heart disease and diabetes in studies like those above, and their potential as part of a diet to lower cancer risk, if you have medical reason to avoid gluten, aim to do it while including gluten-free whole grains and other sources of dietary fiber.
- If you don’t have a gluten sensitivity, ignore claims of benefit from avoiding it. As recommended by guidelines targeting today’s major chronic diseases, and supported by studies like those above, include whole grains as part of overall healthy eating habits. Limit gluten-containing refined grains and sweets, of course, since they provide calories without much nutritional benefit.
- Don’t give whole grains a “health halo”. As nutritious as they are, that doesn’t support eating excess portions. That paves the way for weight gain, which is clearly linked with disease risk, not protection.
Does Checking Package-Front Claims Help?
Messages about healthy eating often urge people to read food labels. Yet two recent studies might shake your confidence about whether you accomplish this by scanning package fronts.
In one study, people in an online survey were shown images of two options for snack chips. Some were vitamin-fortified and had a front-of-package label indicating that the chips were a good source of specific nutrients, while others did not. With or without those front labels, some chips (“healthier” options) were lower in calories, sodium, and saturated fat, and higher in dietary fiber, than others (“less healthy” options). Results showed that people were easily swayed by the “health halo” suggested by a front-of-package banner showing fortification; they were more likely to consider the product healthier, and less likely to bother to check the Nutrition Facts panel to decide about healthfulness. Less than half of participants even clicked to see the Nutrition Facts panel when asked to identify the healthier choice. Those who did were more than 26 times as likely to successfully identify the healthier of two options. But even they were led astray sometimes when less healthy products had those front-of-package banners about being a good source of particular nutrients.
Another study compared the nutrient content of foods labeled as low in fat, sugar or calories. Authors concluded that relying on these claims to choose healthy foods could be confusing, since a food could be relatively low in one of these, yet not necessarily lower than other foods without the package claim. And it certainly doesn’t equate to a food providing nutritional benefits. For example, a low-sugar cookie doesn’t provide the many protective nutrients and plant compounds found in fruit. Past research has shown the “health halo” effect in which people (especially those who are overweight) ate larger servings of foods labeled “low-fat”.
- If a food catches your eye because of a claim highlighted on the package that it is high in a nutrient or low in something you’re trying to reduce, check the Nutrition Facts panel and consider what that food contains in the big picture of overall contents. Be sure to check the serving size that contains those amounts, too, and consider how that compares to the portion you will eat.
- Many cases of these nutrient content claims relate to processed foods. Make plain fresh, frozen and no-salt-added canned vegetables, along with unsweetened fruits and plain whole grains the largest part of your plate at each meal, and you have the foundation for healthy eating that does not require much label-reading. Make these foods delicious with simple herbs, spices, garlic and squirts of citrus or flavored vinegar, which add essentially no sodium, fat, sugar or calories.
Must Healthy Eating Cost More?
Some people contend that healthy eating requires spending much more money. But does it?
Researchers analyzed people’s Healthy Eating Index (HEI-2010) score, which rates how closely their diet follows overall recommendations for a healthy diet, compared to money spent on food, as well as the frequency of eating at home versus eating out. Eating more home-cooked meals was associated with higher healthy eating scores without spending more money on food. Frequent eating out was associated with diets that were less healthy, yet cost more.
- Aiming for the points identified as healthy habits in major dietary recommendations and in the recent JAMA study noted above – more vegetables, fruits, and whole grains along with less sweets, sugary drinks, refined grains and red and processed meats – you hit the key points of healthy eating.
- By not getting distracted with “health halos” from labels of ultra-processed snacks and “convenience” foods, you can choose healthy options and often spend less.
- Information abounds about quick and easy ways to cook at home. Don’t get deterred by envisioning it as a major obstacle. Plan ahead for healthy meals and stock your pantry accordingly.
Eating habits that support your health and vitality now and over the long-haul can’t be defined by one simple choice of what you do or don’t eat. The good news is that studies repeatedly show that your diet need not be “perfect” to make a difference in your health. You can move toward healthier eating habits step by step. Think of your current diet as a bucket. Where are the holes that are allowing potential for supporting health to leak out? Start with the lowest holes in the bucket, seal them up, and move on when you are ready.
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Making sense of food labels?
Check “How to Understand and Use the Nutrition Facts Label” by the FDA.
Changes that will be coming to food labels are described here.
Planning meals for home-cooking that are quick, low-cost and delicious?
Afshin A. and Sur P. The Impact of Suboptimal Diet on Cardiovascular Disease Mortality in the United States. March 9, 2017. American Heart Association Epi/Lifestyle conference. Portland, Oregon.
Cani PD et al. Involvement of gut microbiota in the development of low-grade inflammation and type 2 diabetes associated with obesity. Gut Microbes, 2012; 3(4):279-288.
Micha R et al. Association between dietary factors and mortality from heart disease, stroke, and type 2 diabetes in the United States. JAMA. 2017, 317(9):912-924
Taillie LS et al. No Fat, No Sugar, No Salt . . . No Problem? Prevalence of “Low-Content” Nutrient Claims and Their Associations with the Nutritional Profile of Food and Beverage Purchases in the United States. J Acad Nutr Diet. 2017, epub ahead of print. http://dx.doi.org/10.1016/j.jand.2017.01.011
Tiwari A et al. Cooking at Home: A Strategy to Comply With U.S. Dietary Guidelines at No Extra Cost. American Journal of Preventive Medicine, 2017, epub ahead of print. http://dx.doi.org/10.1016/j.amepre.2017.01.017
Verrill L et al. Vitamin-Fortified Snack Food May Lead Consumers to Make Poor Dietary Decisions. J Acad Nutr Diet. 2017, 117(3):376-385.
Zong G et al. Associations of Gluten Intake with Type 2 Diabetes Risk and Weight Gain in Three Large Prospective Cohort Studies of US Men and Women. Circulation. 2017;135:A11