Eat, Drink, and Be Healthy

by Walter Willett

  CELIAC DISEASE

  If you have celiac disease, you know the problems that even a few crumbs of bread can cause: gas, bloating, abdominal cramps, diarrhea, and more. The cause is gluten, a mixture of proteins found mainly in wheat, rye, and barley. People with celiac disease can’t tolerate gluten. For some reason, their immune systems see gluten as a foreign invader. Over time, the attack on gluten damages the lining of the small intestine, leading to weight loss, skin rashes, osteoporosis, infertility, nerve damage, seizures, and more.

  People with celiac disease must do everything they can to avoid foods that contain gluten. Common gluten-containing foods include traditional breads and pastries made from wheat or rye, noodles and pasta, crackers and other baked goods, many breakfast foods, flour tortillas, and beer, to name just a few.

  The rapid proliferation of gluten-free foods is making it easier to avoid gluten. Even so, it can lurk in unexpected foods such as soy sauce, french fries, processed meats, prepared soups and sauces, and herbal supplements.

  As I described in “Gluten in Grains: A Danger for Some” on page 130, a related condition, called gluten sensitivity or non-celiac gluten sensitivity, can generate symptoms similar to celiac disease but without the intestinal damage.

  If you need to go gluten free, or decide to do it, try to find new ways to get folic acid, other B vitamins, and dietary fiber, which the bowels need to work properly. You can do this by eating fruits, vegetables, beans, and non-gluten grains such as brown rice or quinoa.

  DEPRESSION

  Many people are afflicted with depression at some point in their lifetimes. Globally, it is among the most important causes of disability. Depression can be mild and brief or prolonged and severe. Seeking professional help is important in any case.

  Maintaining overall wellness through diet and regular physical activity can help promote good mental health. One specific aspect of diet linked to mental health is consumption of caffeinated coffee, which is strongly related to lower risk of depression and suicide.5 In both the Nurses’ Health Study and Health Professionals Follow-Up Study, women and men who consumed three or more cups of coffee per day had about half the risk of suicide compared with those who didn’t drink coffee. This isn’t surprising, because coffee has long been known to have mild mood-elevating effects. We also found that consumption of flavonoid-containing fruits and vegetables, especially citrus fruits and juices, was associated with lower risk of depression.6

  In spite of intense interest in the possibility that higher intake of omega-3 fats might prevent depression, the evidence for this is weak. Some researchers have hypothesized that higher dietary intakes of omega-6 fatty acids, found in many plant oils like soybean and corn oil, could increase the risk of depression by boosting inflammation throughout the body. But higher intake of omega-6 fats may actually reduce inflammation.7 In our investigation of suicide risk, we saw no evidence of a reduction in suicide with a higher intake of omega-3 fats or lower intake of omega-6 fats.8

  MEMORY LOSS

  Because the average American is living longer—thanks mainly to reductions in smoking, improvements in diet, and earlier diagnosis and better treatments of medical conditions—age-related memory loss (dementia) is an increasing burden on individuals and family members. However, there is good news in the trend seen over the last few decades. When comparing people of similar ages, the incidence of dementia has decreased by more than 40 percent since the late 1970s.9 But because our population is aging, the actual number of people with dementia is increasing, and there is currently no satisfactory medical treatment for it.

  There is exciting evidence that a Mediterranean-type dietary pattern can reduce the risk of memory loss and slow the course of this process. This isn’t completely surprising, because the factors that lead to memory loss and dementia include damage to the brain’s blood supply and the occurrence of multiple small strokes. A poor diet may also promote processes in the brain related to Alzheimer’s disease, a common form of dementia. Both cardiovascular disease and Alzheimer’s disease develop slowly over many decades, providing major opportunities for prevention by diet. A Mediterranean-type diet pattern is proven to reduce these and other forms of cardiovascular disease. But even once memory loss has begun, slowing its progression through diet can be valuable.

  Many types of studies, including long-term epidemiologic studies, have examined the connection between diet, memory loss, and dementia. These were recently reviewed by my colleague, Martha Clare Morris, and her team. They identified a variety of foods that were related to better thinking skills. These include vegetables, especially green leafy vegetables, berries, nuts, olive oil, whole grains, fish, poultry, and wine taken moderately. Foods linked to poorer thinking skills included red meat, fast fried food, pastries, and sweets. Sound familiar?

  Morris created a score based on these foods, which she called the MIND diet score, and tested it in a group of almost 1,000 older men and women taking part in the Memory and Aging Project at Rush University Medical Center in Chicago. Over a five-year period, higher MIND scores—meaning healthier eating—were associated with better scores on thinking and memory tests.10 As is the case for cardiovascular disease, the strong benefit of the MIND dietary pattern likely comes from multiple foods, not a single nutrient. However, we do know that beta-carotene is one of the contributors to a healthier brain because of its beneficial effect on cognitive function when given as a supplement in the Physicians’ Health Study (see “New Hope for Multivitamins” on page 236). Further support for the connection between healthy eating and preserved memory and thinking skills comes from the PREDIMED randomized trial, in which participants who followed a Mediterranean-type dietary pattern experienced better cognitive function compared to those on a control diet.11

  It only makes sense that a diet that is good for many other organs is also good for the brain. While ongoing research aims to understand the effects of specific dietary factors on the brain, adopting a Mediterranean-type diet that includes a variety of foods high in carotenoids will put you on a path to better long-term cognitive function. Starting on this path as early in life as possible is best, but from what we have seen in other health outcomes, you can still reap the benefits of a healthy diet even if you start once symptoms have developed.

  CHAPTER FIFTEEN

  * * *

  Shopping Tips, Recipes, and Menus

  EATING HEALTHFULLY, AS YOU’VE LEARNED earlier in this book, is not a complicated concept. Simply put, it involves building an eating style that is based on whole grains, fresh produce, good fats, and healthy protein “packages.” To get you started in the right direction, my wife, Gail, and I have developed a group of seventy-seven recipes, everything from Curried Winter Squash Soup to Fruit ’n’ Spicy Nut Trail Mix, that will tempt your taste buds and renew your faith that eating for good health can be a delicious endeavor. Some of the recipes are quick fixes that can go from preparation to table in under thirty minutes. Others take a bit more time, but include classic favorites like multigrain hotcakes, chili, and fried rice.

  In general, these recipes represent just good, healthy food and so don’t require any major manipulations. Although the recipes aren’t specifically geared toward weight loss and require no special culinary skills, just the fact that they emphasize whole grains, fruits, vegetables, nuts, seeds, and legumes should make it easy to work these recipes into a weight-loss plan, because the quality of your diet is as important to long-term weight control as the quantity of your diet.

  If you are battling with excess weight, you already know there is no quick fix. As discussed in chapter four, you’ll need to become more active, find a diet that’s right for you, and practice defensive eating (see pages 64 to 66). This section of the book will give you an easy, delicious way to find foods that are right for you.

  If you are looking to lose weight, at the bottom of each day’s menu is some advice on how to adapt the menu to a reduced-calorie plan. Losing weight isn’t about deprivation.
It’s about moderation and choosing high-quality food. So don’t put favorite foods on a taboo list; just learn to eat them in smaller portions and less frequently. At the same time, take delight in truly good, fresh food. A just-picked juicy sweet peach. Steamed fresh green beans with a squeeze of lemon juice and a sprinkle of pepper. A hot-off-the-grill salmon steak. Your tastes may eventually start shifting away from salty, sugary, overprocessed foods and wake up to a whole wonderful world of fresh, clean flavors. Who knows, your list of favorites might just change completely.

  This section also includes a week’s worth of menus to help you get started planning healthful meals.

  CHOOSE NUTRITION-PACKED FOODS

  While there are no superfoods that contain every single nutrient needed for good health, some foods pack more nutrients per calorie than others. By choosing nutrient-dense foods, the overall quality of your diet will improve practically overnight. For the most part, that means eating whole grains, fruits, and vegetables at every meal. Here are some tips to get you started.

  Add dark leafy greens to salads. Dark leafy greens contain more nutrients than iceberg lettuce. Spinach, kale, and romaine lettuce, for example, contain everything from iron to folate to fiber. Iceberg lettuce, on the other hand, is mostly water. A good rule of thumb: The darker the green, the more nutrients a leafy vegetable contains.

  Sprinkle wheat germ on cereals, casseroles, or yogurt. Adding 2 tablespoons of wheat germ boosts the fiber nearly 2 grams but adds only 51 calories. Use the toasted variety for a nuttier flavor.

  Serve a whole grain as a side dish instead of potatoes. White potatoes and grains like bulgur and wheat berries are considered starchy side dishes. But the potatoes have nowhere near as much fiber and are not as nutrient dense as whole grains. In addition, the body quickly turns the starch in white potatoes into sugar, causing a quick spike in blood sugar and insulin. Whole grains are digested more slowly, causing a lower and more even rise in blood sugar.

  Snack on whole-grain crackers rather than those made with processed flour. Whole-grain crackers such as Triscuit or Ak-mak contain more fiber than those made with refined flour. That fiber can add up if you’re a regular snacker. Even better, think of nuts as an alternative. They are probably the healthiest hunger-blunting snack you could have.

  Try the “three pleasures” for dessert instead of ice cream or cake. Instead of a traditional calorie-laden dessert, create one from three of the healthiest foods you can eat: fruit, nuts, and dark chocolate. This offers a sweet, delicious way to end a meal that’s also good for your health and your waistline. When Gail and I have dessert at home, this is usually what we make. When we dine out, I have been challenging chefs around the country to redesign dessert to focus on these foods, which I call the Three Pleasures. We have experienced many wonderful creations. You can find more details and “business cards” to give to your waiter at Google hsph.me/3fordessert.

  Making Better Food Choices

  * * *

  Eat This

  Not That

  whole grain bread

  white bread

  brown rice or other intact grains

  white rice or potatoes

  olive or other liquid oils

  butter

  peanut butter

  cheese or bologna for a sandwich

  nuts on a salad

  cheese on a salad

  nuts as a snack

  sweets as a snack

  Three Pleasures for dessert

  cheesecake, ice cream, or other usual desserts

  beans, soy, fish, or poultry

  red meat

  plain yogurt with added fruit and nuts

  ice cream

  HEALTHFUL SUBSTITUTIONS

  No single food will make or break good health. But the overall quality of your diet—the kinds of foods you choose to eat day in and day out—does have a major impact. Good diets, ones that promote well-being, are built mainly on nutrient-dense choices: foods that contain healthful fats, fiber, and a whole host of other nutrients and phytochemicals. I urge you to enjoy food. But when push comes to shove, make choices that are high in flavor and good for health.

  One important step is to replace unhealthy saturated and trans fats with healthful unsaturated fats (see “Replacing Unhealthy Fats with Healthier Ones” on page 106). And make it a point to start adding more whole grains, fruits, and vegetables to meals. Here are some suggestions for achieving those goals.

  Directory of Whole or Intact Grains

  Grains have nourished humans since early times. But somewhere along the way most of us have lost touch with their goodness. Here’s a brief overview of whole and intact grains, an A-to-Z list with what you need to know about cooking techniques, storage guidelines, and taste. Remember, whole grains are unrefined but can be available as flour; intact grains are just that.

  Intact Grain Versus Whole Grain

  * * *

  Grains are the seeds of plants that are mostly in the grass family. Each intact grain has three parts: the bran, the germ, and the endosperm.

  The bran surrounds the grain. It provides protection so the seed can endure harsh conditions and still germinate many months or years later. Even though the brain is mostly indigestible fiber, many minerals and vitamins are closely attached to it.

  The germ is the embryonic plant that will sprout and grow when the temperature and moisture conditions are right. The delicate living tissues in the germ are bathed in unsaturated oil, which also contains a large amount of fat-soluble antioxidants, such as vitamin E, to protect the oil from becoming oxidized.

  The endosperm provides energy for the germinating seed until it can begin to make its own food through photosynthesis. It is mainly starch. Over the years, grains have been bred to grow larger and larger endosperms, meaning more and more starch. Although the endosperm contains other nutrients, too, the amounts are low compared to the calories from starch.

  Intact grains are grains that have been minimally processed to remove them from the seed head and to remove grit and other impurities. They have not been smashed, pulverized, steamed, or undergone other processing. Examples of intact grains include wheat berries, brown rice, millet, oat groats, and quinoa.

  Whole grains, and foods made from them, are intact grains that have been processed in one way or another, often by milling, which grinds up the grain. They still contain the bran, germ, and endosperm.

  In contrast, refined grains such as wheat flour (not “whole wheat” flour), have had the bran and germ removed. Vitamins and minerals are often added to this depleted flour, which is then sold as “enriched” flour. While that may sound healthy, what’s added is only a small fraction of the many nutrients and phytochemicals that the original grain contained.

  Whole grains are significantly better for you than refined grains because they deliver all the nutrients that were in the intact grain. But they aren’t as good as intact grains. One reason is that milling chops up the grains, disrupting the bran layer. It no longer covers the endosperm, opening it up to faster attack by starch-digesting enzymes. This speeds the conversion of starch to blood sugar. Grinding the endosperm into fine particles also makes it easier for starch-digesting enzymes to do their job. The result is that intact grains have a lower glycemic index (see page 117), which results in slower and lower rises in blood glucose, less demand for insulin, and lower risk of type 2 diabetes. The lower glycemic index of intact grains helps you feel full longer after a meal or snack and delays the onset of hunger.

  Amaranth

  Cultivated by the Aztecs, this yellow-gold seed has a crunchy texture that softens only slightly when cooked. In fact, its creamy-crunchy texture is so much like the consistency of hot cereals that this is the way the grain is most often eaten. For the adventurous, amaranth (pronounced AM-uh-ranth) can be tucked into baked goods (see Banana-Apricot Nut Bread, page 306) or mixed with other grains to make a pilaf or casserole. Try toasting the seeds in a dry skillet; they expand and “pop” just like corn.
Sprinkle the crunchy popped kernels on salads, vegetables, and pizza.

  Cooking rating: Easy but time-consuming. Amaranth must be simmered in a large amount of water (1 part grain to 3 parts water) for twenty-five to thirty minutes to eat as cereal. To use in baked goods, presoak in boiling water.

  Nutritional benefits: Cholesterol-free with a small amount of fat, most of it unsaturated. Rich in iron, with 60 percent of the required amount in 1/4 cup of the dry seed. Good source of fiber—3 grams per 1/4 cup dry—but not as high in fiber as some other whole grains. Also a good source of calcium, with small amounts of B vitamins.

  Shopping tip: It’s unlikely you will find this grain at the supermarket. It can be found in most specialty stores or ordered online. (See website information in the section that follows this dictionary.)

  Barley

  This nutty-flavored whole grain is sold in many different forms: hulled, pearled, flakes, and grits. The pearled variety is the most common and most versatile. It retains a chewy texture even after long periods of cooking. That makes it a good candidate for soups, casseroles, and even a whole-grain risotto (see Wild Mushroom–Barley Risotto, page 367).

  Cooking rating: Easy but time-consuming.

  Whole hulled barley: Must be soaked overnight and then simmered for an hour or more.

  Pearled barley: Made from grains that are split but still contain the center, or “pearl.” Thanks to the refining, you can skip the soaking step and shave thirty minutes off the cooking time. If that’s not fast enough, look for quick-cooking pearl barley, which cooks in ten minutes.

  Flakes/grits: Barley flakes, which resemble rolled oats, can be made into hot cereal or soup. Barley “grits” are a fine grind of the grain used for hot cereal.