So for the purposes of the Traffic Light model, I like to think of “unprocessed” as nothing bad added, nothing good taken away. In the above example, tomato juice could be thought of as relatively unprocessed because even much of the fibre is retained—unless salt is added, which would make it a processed food in my book and bump it right out of the green zone. Similarly, I would consider chocolate—but not cocoa powder—processed because sugar is added.
Using my definition of nothing bad added, nothing good taken away, steel-cut oats, rolled oats, and even (plain) instant oatmeal can all be considered unprocessed. Almonds are obviously a whole plant food. I would also consider no-salt-added almond butter to be a green-light food, but even unsweetened almond milk is a processed food, a food from which nutrition has been stolen. Am I saying almond milk is bad for you? Foods are not so much good or bad as they are better or worse. All I’m saying is that unprocessed foods tend to be healthier than processed ones. Think of it this way: Eating almonds is healthier than drinking almond milk.
The limited role I see for yellow-light foods in a healthy diet is to promote the consumption of green-light foods. For instance, if the only way I can get patients to eat oatmeal in the morning is if they make it creamy with almond milk, then I tell them to go right ahead. The same could be said for red-light foods. Without hot sauce, my intake of dark-green, leafy vegetables would plummet. Yes, I know there are all sorts of sodium-free, exotically flavored vinegars out there that I could use, and maybe one day I’ll wean myself off Tabasco. But given my current tastes, the green ends justify the red means. If the only way you’re going to eat a big salad is to sprinkle Bac-Os on top, then sprinkle away.
Bac-Os are what are referred to as ultraprocessed foods, bearing no redeeming nutritional qualities or resemblance to anything that grew out of the ground and often containing added rubbish. Bac-Os, for example, have added trans fats, salt, sugar, and Red 40, a food dye banned in a number of European countries.39 As a red-light food, it ideally should be avoided, but if the alternative to your big spinach salad with Bac-Os is KFC, then it’s better to have the salad with the Bac-Os. They can be the spoonful of sugar that makes the medicine go down. The same goes for real bacon bits, for that matter.
I realize some people have religious or ethical objections to even trivial amounts of animal products. (Growing up Jewish near the largest pig factory west of the Mississippi, I can relate to both sentiments.) But from a human health standpoint, when it comes to animal products and processed foods, it’s the overall diet that matters.
What Does “Whole-Food, Plant-Based” Mean, Exactly?
Sometimes people’s diets take on a religiosity of their own. I remember a man once telling me that he could never “go plant based” because he could never give up his grandma’s chicken soup. Huh? Then don’t! After I asked him to say hello to his bubby for me, I told him that enjoying her soup shouldn’t keep him from making healthier choices the rest of the time. The problem with all-or-nothing thinking is that it keeps people from even taking the first steps. The thought of never having pepperoni pizza again somehow turns into an excuse to keep ordering it every week. Why not scale down to once a month or reserve it for special occasions? We cannot let the “perfect” be the enemy of the good.
It’s really the day-to-day stuff that matters most. What you eat on special occasions is insignificant compared to what you eat day in and day out. So don’t beat yourself up if you really want to put edible bacon-flavored candles on your birthday cake. (I’m not making those up!40) Your body has a remarkable ability to recover from sporadic insults as long as you’re not habitually poking it with a fork.
This book is not about vegetarianism, veganism, or any other “-ism.” There are people who completely eliminate any and all animal products as part of a religious or moral stance and may indeed end up better off as a side benefit.41 But strictly from a human health standpoint, you would be hard pressed to argue, for example, that the traditional Okinawan diet, which is 96 percent plant based,42 is inferior to a typical Western, 100 percent vegan diet. In Kaiser Permanente’s guide “The Plant-Based Diet: A Healthier Way to Eat,” the authors define a plant-based diet as one that excludes animal products completely, but they make sure to note: “If you find you cannot do a plant-based diet 100 percent of the time, then aim for 80 percent. Any movement toward more plants and fewer animal products can improve your health!”43
From a nutrition standpoint, the reason I don’t like the terms vegetarian and vegan is that they are only defined by what you don’t eat. When I used to speak on college campuses, I would meet vegans who appeared to be living off french fries and beer. Vegan, technically, but not exactly health promoting. That’s why I prefer the term whole-food, plant-based nutrition. As far as I can discern, the best available balance of evidence suggests that the healthiest diet is one centered on unprocessed plant foods. On a day-to-day basis, the more whole plant foods and the fewer processed and animal products, the better.44
Preparing Yourself for Healthier Habits
First, you need to know your own psychology. There are certain personality types that do better when they go all in. If you tend to have an “addictive” personality, or if you are the kind of person who takes things to extremes—for instance, you either don’t drink at all or you drink in excess—it’s probably best for you to try to stick with the program. But some individuals can get away with “social smoking,” for example; they can light up a few times a year and escape nicotine dependence.45 The reason we as physicians advocate for smokers to quit completely is not because we think that one cigarette every once in a while is going to do irreversible damage but because we’re afraid that one cigarette may lead to two, and, before long, the unhealthy habit has taken hold. Similarly, one (well-cooked) hamburger is not going to kill anyone. It’s what you eat day to day that adds up. You have to take stock of your disposition to know if you can overcome the risk of sliding down the slippery slope.
There’s a concept in psychology called “decision fatigue” that marketers use to exploit consumers. It appears humans have a limited capacity to make many decisions in one short stretch of time, and the quality of our decisions will deteriorate to the extent that we eventually begin making downright irrational choices. Ever wonder why supermarkets stack the junk food at the checkout counter? After wading through the forty thousand items in the average supermarket,46 we end up with less willpower to resist impulse purchases.47 So making rules for yourself and sticking to them may help you make more sensible choices over the long run. For instance, making a strict decision to never cook with oil, to avoid meat entirely, or to eat only whole grains may paradoxically make for sturdier life changes. By not having junk food in the house, you remove the temptation by removing the choice. I know if I get hungry enough I’ll eat an apple.
There may also be a physiological argument for not wildly deviating from a well-planned diet. After a vacation cruise during which you indulged in all manner of rich foods, your palate may get dulled to the point where the natural foods you enjoyed just the week before no longer deliver the same taste satisfaction. For some, this may simply require a period of readjustment. But for others, this departure from an otherwise healthy diet may lead back to a dietary glut involving added salt, sugar, and fat.
For those of us who grew up eating SAD (the Standard American Diet), starting to eat healthfully can be a big shift. I know it was for me. Though my mum tried to keep us eating good-for-us foods at home, when I was hanging out with friends, we’d go through boxes of Little Debbie snack cakes and indulge in greasy meals at the local Chinese restaurant, where I’d order spareribs or any other dish with chunks of deep-fried meat. One of my favorite snacks was nacho cheese-flavored Slim Jims.
Thankfully, I was able to escape SAD’s clutches before any overt health problems arose. That was twenty-five years ago. Looking back, I view that as one of the best decisions of my life.
Some go cold turkey, if you will, wh
ile others transition more slowly using a variety of approaches. One I’ve used personally in my medical practice is Kaiser Permanente’s three-step method. Realizing that most American families tend to rotate through the same eight or nine meals, step one suggests that you think of three meals you already enjoy that are plant based, like pasta and marinara sauce that could be easily tweaked to whole-grain pasta with some added veggies. Step two asks you to think of three meals you already eat that could be adapted to become a green-light meal, like switching from beef chili to five-bean chili. Step three is my favorite: Discover new healthy options.48
Ironically, many people following healthy diets report eating an even greater variety of foods than when they ate their former “unrestricted” diet. Before widespread use of the Internet, I used to tell people to go to their public libraries and borrow cookbooks. Today, Google whole-food, plant-based recipes, and a million hits pop up. If you’re feeling overwhelmed, good places to start include:
• ForksOverKnives.com: This site of the wildly popular documentary and book of the same name offers hundreds of recipes.
• StraightUpFood.com: Cooking instructor Cathy Fisher shares more than one hundred recipes on this site.
• HappyHealthyLongLife.com: This site’s tagline reads: “A [Cleveland Clinic] medical librarian’s adventures in evidence-based living.” She used the e word—I think I’m in love!
Once you’ve found three new meals you enjoy and can prepare with ease, step three is complete. You now have a nine-meal rotation, and you’re off! After that, moving on to breakfast and lunch is easy.
If you hate to cook and just want the cheapest, easiest way to make healthy meals, I highly recommend dietitian Jeff Novick’s Fast Food DVD series. Using common staples like tinned beans, frozen vegetables, quick-cook whole grains, and spice mixes, Jeff shows you how you can feed your family healthfully in no time for under three pounds a day per person. The DVDs also include supermarket store walk-throughs, shopping tips, and information on how to decipher nutrition labels. Check out his cooking series at JeffNovick.com/RD/DVDs.
If you crave more structure and social support, the Physicians Committee for Responsible Medicine (PCRM), a nonprofit nutrition research and policy advocacy organization in Washington, D.C., has a fantastic three-week kick-start program for plant-based eating. Check it out at 21DayKickstart.org. This free online nutrition program starts the first of every month and offers a full meal plan, recipes, tips, resources, a restaurant guide, and a community forum. As of this writing, it’s offered in four languages. Hundreds of thousands of people have already benefited from it, so feel free to give it a try.
I’ve always tried to get my patients to think of healthy eating as an experiment. It can be overwhelming to think of such a sweeping change as permanent. That’s why I ask them to give me just three weeks. I find that if my patients think of it simply as an experiment, they’re more likely to go whole hog (whole grain?) and realize the maximum benefits. But that’s just me being sneaky. I know that once those three weeks are up, if they really gave it their all, they will be feeling so much better, their lab values will be looking so much better, and their palates will have started to change. Healthy eating tastes better and better the longer you stick with it.
I remember talking about this with Dr. Neal Barnard, founding president of PCRM, which publishes a great deal of research pitting a healthy diet against a variety of common ailments—everything from acne and arthritis to menstrual cramps and migraines. He often uses what’s called an “A-B-A” study design. Participants’ health is assessed at baseline on their regular diets, and then they’re switched to a therapeutic diet. In an effort to make sure any health changes participants experience on the new diet aren’t merely a coincidence, they are then switched back to their regular diet to see if the changes disappear.
This kind of rigorous study design improves the validity of the results, but the problem, Dr. Barnard related, is that sometimes people improve too much. After a few weeks on a plant-based diet, sometimes people feel so much better that they refuse to go back on their baseline diet49—even though it’s required by the study protocol. Since they didn’t complete the study as planned, their data have to be effectively thrown out and may never make it into the final paper. Ironically, healthy eating can be so effective that it undermines its own studies of effectiveness!
WWDGE: What Would Dr. Greger Eat?
I’m regularly asked what I eat every day. I’ve always been hesitant to answer for a number of reasons. First, it shouldn’t matter what I or anyone else eats, says, or does. The science is the science. Too much of the nutrition world is split into camps, each following their respective guru. What other field of serious scientific inquiry is like that? After all, 2 + 2 = 4 regardless of what your favorite mathematician thinks. This is because there isn’t a trillion-dollar industry that profits from confusing people about arithmetic. If you were getting conflicting messages from all sides about basic maths, in desperation, you might have to choose one authority to stick with, hoping that person will accurately represent the available research. Who has time to read and decipher all the original source material?
Early on in my practice, I decided that I didn’t want to rely on anyone else’s interpretation for what could ultimately be life-or-death decisions for my patients. I had the access, the resources, and the background to interpret the science on my own. When I initially began my annual reviews of the nutrition literature, it was really just to make myself a better doctor. But when I discovered such a treasure trove of information, I knew I couldn’t keep it to myself. My hope is to disseminate it in a way that removes me as much as possible from the equation. I don’t want to present the trademarked Dr. Greger Diet; I want to present the best-available-evidence diet. That’s why I show the original papers, charts, graphs, and quotes with links to all the primary sources in my NutritionFacts.org videos. I try to keep my own interpretation to a minimum—though admittedly, I sometimes can’t help myself!
What a person chooses to do with information is highly personalized and often depends on such factors as his or her current life situation and how risk averse he or she is. Given the same information, two people can make two entirely different but legitimate decisions. For this reason, I’ve been hesitant to share my own personal choices, because I’m afraid they’ll unduly sway people to make decisions that might not be right for them. I’d rather just present the science and let others decide for themselves.
In addition, everyone’s taste buds are different. I can imagine someone thinking, He puts hot sauce on what? When people hear me talk about the wonders of hummus (a Middle Eastern chickpea spread) but not baba ganoush (a Middle Eastern roasted-aubergine spread), they might come away with the impression that I think one is healthier than the other. This may be (and probably is, actually), but my real reason is simple: I don’t like the taste of aubergine.
Conversely, just because I eat something doesn’t mean it’s healthy. For example, people are surprised to hear I use dutched (alkali-processed) cocoa. In that process, more than half of the antioxidants and flavanol phytonutrients are wiped out.50 Why would I use it, then? Because it tastes so much better to me than unprocessed cocoa. While I encourage people to use natural cocoa, I don’t take my own advice in that regard. In some cases, it would be better if people would do as I say, not as I do.
And what if I shared a recipe that someone found utterly repulsive? I would hate for him or her to think, If this is healthy eating, count me out! As you eat healthier, your palate actually changes. It’s an amazing phenomenon. Your taste buds are constantly adapting—minute to minute, in fact. If you drank some orange juice right now, it would taste sweet. But if you first ate some sweets and then drank the same OJ, it could taste unpleasantly bitter. Over the long term, the more you eat healthfully, the better healthy foods taste.
I remember the first time I sipped a green smoothie. I was speaking somewhere in Michigan, hosted by a darling phys
ician couple. They told me that they drank “blended salads” for breakfast. Intellectually, I loved the idea. Greens, the healthiest food on the planet, in convenient liquid form? I envisioned myself drinking a salad on my way to work every day. But then I tasted it. It felt like I was drinking someone’s lawn. I gagged and almost threw up over my hosts’ kitchen table.
Green smoothies are something you have to build up to. Everyone loves fruit smoothies. A frozen banana, strawberries—yum! And surprisingly, you can throw a handful of baby spinach in there and you may hardly even taste it. Give it a try! You’ll be surprised. Okay, so if one handful is good, how about two? Slowly, your taste buds can adapt to increasing quantities of greens. This happens with all your senses. Walk into a dark room, and your eyes will slowly adapt. Stick your foot into a hot bath, and though at first it may be too hot, your body equilibrates to a new normal. Likewise, in just a couple of weeks, you can be drinking—and enjoying—concoctions you’d now consider absolutely wretched.
Having said all that, I will now proceed to tell you what I eat, what I drink, what I do, and how I do it. In each subsequent chapter, I will dive deeper into each of the entries on my Daily Dozen checklist to describe which types of these green-light foods are my favorites, as well as the tricks and techniques I use to prepare them. I will not be detailing every type of bean, fruit, vegetable, nut, or spice that I eat. Rather, my goal here is to explore some of the interesting science behind a few of my favorite options in each category.
Please understand that my strategy is a way to do it rather than the way to do it. If it happens to work for you too, great. If not, I hope you’ll explore the myriad other ways you could use this same body of evidence to help improve and prolong your life.
How Not to Die Page 35