• Forget about dieting and weight loss and focus on eating healthy and exercising more.
• Consider a healthy dietary pattern and not the percentage of macronutrients in the diet.
• Consider food as medicine and medicine as food.

Basic rules to healthy nutrition

1. A good diet starts with eating mostly fruit, vegetables and whole grains.
2. Minimize highly processed foods, that means if it’s in a box, a can, or bag try to avoid it.
3. Be mindful of hidden and added sugars and carbohydrate quality.
4. Avoid sugary beverages like soda, flavored water or fruit juice.
5. Read labels: most salt consumed is in processed foods and not the salt shaker.
6. Portion control: avoid “eat all you can eat”.
7. Meat is not forbidden but avoid processed meats
8. Drink alcohol in moderation
9. Be aware of the health “halo-effect” and other deceptive marketing ploys.

A healthy eating pattern is very different that the traditional Western diet and emphasizes fruit, vegetables, and whole grains while minimizing processed foods, added sugars and processed meats.

Western diet and processed foods

In Western societies our food has changed dramatically. For “convenience” our food has been largely engineered in the chemistry lab, packaged and sold to us. In the “processing” of our food nutrients are stripped (without natural vitamins and nutrients even the microbes don’t like these foods) so they last longer on the shelf. To increase sales salt, sugar and fat are added to provide flavor (since natural flavors and nutrients are now gone) while portion sizes increase. This concept is applied not just to the majority of packaged goods sold but also to refined carbohydrates (that’s what “refined” refers to).

As a result when natural grains, such as wheat, are refined and stripped of the nutrients (for example to make white bread) what you’re left with is a simple carbohydrate. Our body treats these simple carbohydrates just like sugar. Excessive saturated fat, added sugars, salt (and a couple of other particularly harmful additives such as high fructose corn sugar and trans fats) have been directly linked to the obesity epidemic. In the US over 60% are over-weight or obese and with the twin epidemics of obesity and diabetes affecting children in record numbers it is expected that for the first time in history our children will have a shorter life expectancy than their parents.

In the United States this question has been largely hijacked by those promoting weight loss strategies. The majority of these weight loss diet plans are not based on scientific investigation. When analyzing any particular diet ask the following questions:

1. Has this particular diet caused safe and lasting weight loss?
2. When consuming this particular diet are people healthier?
3. When consuming this diet do people live longer and have less disease?
4. If these questions can not be answered, then where does the data come from to justify their claims?

When analyzed in such a way only a few dietary patterns can stand up to the challenge. Large population studies have shown that people who eat predominantly a plant-based diet consisting of natural fruits (not fruit juices), vegetables and grains while minimizing processed foods have less cardiovascular disease, cancer, diabetes and obesity and as a result they live longer.

It is not dieting, it’s a healthy dietary pattern

• Strive to eat a healthy dietary pattern consisting of fruits, vegetables, whole grains, while minimizing (note: I did not say it’s necessary to eliminate) processed foods.
• Red meat is ok in small portions and fish is better.
• In developing a healthy relationship to food discover and buy more produce and vegetables that you enjoy. Discover new ones.
• Introduce more whole grains into your diet. Eat at home more and pack a light lunch when going to work more often. You will find dining out often is not actually more convenient and it is certainly more expensive.

American Heart Association dietary recommendations are based more on achieving a healthy dietary pattern and not simply a percentage of macro nutrients (ie. percentage of fat, carbohydrates or protein). Tracking the percentages of these macro nutrients has not resulted in weight loss long term or a healthier state of being. Once could say such a focus has contributed to this unhealthy struggle with food so many endure. Food is far more complex than simply reducing it to a combination of fat, protein and carbohydrates. There are thousands of other healthy compounds in food (and certainly many more yet to be identified) that can only be obtained with eating a dietary pattern based on a variety of fruit, vegetables, whole grains, high in fiber and supplemented with nuts, seeds and fish. Medical research is now clear, in order to optimize health and prevent disability and premature death we should focus on eating a healthy DIETARY PATTERN.

What are the “diet” plans that best fulfill this healthy eating pattern?

• DASH
• Mediterranean
• Vegetarian

The DASH pattern:

The DASH Diet (Dietary Approach to Stop Hypertension) was designed to test the effects of diet on the management of high blood pressure (hypertension).

There are 50 million people in the US with hypertension (high blood pressure) and approximately 1 billion worldwide. The higher the blood pressure, the greater is the chance of heart attack, heart failure, stroke, and kidney disease.  Subsequently, the  National Institutes of Health (NIH) conducted a study to evaluate the effects dietary patterns on blood pressure.

The DASH trial was a multi-center, randomized feeding study that tested the effects of dietary patterns on blood pressure. As a trial of dietary patterns rather than individual nutrients, DASH tested the combined effects of nutrients that occur together in food. The DASH diet was high in whole grains, poultry, fish, and nuts while being lower in red meat content, sweets, and sugar-containing beverages.

In the study the DASH diet was compared to the typical western diet that served as the control.

459 participants were studied for an 8-week period in which the subjects were provided the diet to which they had been randomly assigned.

In conclusion, a diet rich in fruits, vegetables, and low-fat dairy foods and with reduced saturated and total fat can substantially lower blood pressure. (N Engl J Med 1997; 336:1117-1124)

The Mediterranean pattern

A Mediterranean dietary pattern (with many components found in the well-studied DASH diet pattern and the American Heart Association 2020 program) has a large amount of clinical and experimental evidence in support of many health benefits including survival advantage, a very unique nutrition claim. A Mediterranean pattern is a dietary pattern rich in fruits, vegetables, whole grains, and low-fat dairy foods, fish, poultry, nuts and beans; and limited sugar-sweetened foods and beverages, red meat, and added fat. It is a diet based on the traditional cuisines of countries that border the Mediterranean Sea, such as Italy, France, Spain, Greece and Morocco.

Collections of smaller dietary studies can be grouped together to improve their statistical power (meta-analysis) and have reported that Mediterranean diets appear to be more effective than low-fat diets in inducing clinically relevant long-term changes in cardiovascular risk factors and inflammatory markers. (Nordmann, AJ et al. Meta-Analysis Comparing Mediterranean to Low-Fat Diets for Modification of Cardiovascular Risk Factors  The American Journal of Medicine, Vol 124, No 9, September 2011).

Lyon Heart Study

The Lyon Diet Heart Study published in 1994, was a randomized, controlled secondary prevention trial (a trial in people with known heart disease), that tested the effectiveness of a Mediterranean-type diet on measures of the coronary artery disease recurrence rate after a first myocardial infarction (heart attack).  Despite a similar coronary risk factor profile (plasma lipids and lipoproteins, systolic and diastolic blood pressure, body mass index, and smoking status), subjects following the Mediterranean-style diet for 2 years had an impressive reduction in the combination of cardiac death and non-fatal heart attack by 73%.

PREDIMED

The PREDIMED study was the first large, randomized primary prevention trial (healthy people without disease) designed to study the effects of the Mediterranean dietary pattern (a dietary pattern rich in olive oil, nuts, fish, whole grains, fruits, vegetables, and healthier fats) on cardiac disease. It was a multi-center clinical trial of more than 7,000 individuals. After nearly 5 years those randomly assigned to the PREDIMED Mediterranean dietary pattern revealed:

• The PREDIMED study dietary pattern provided a clinically significant 30% reduction of major cardiac events, which is arguably as or more powerful than many of our best cardiac drugs.
• Adherence to the PREDIMED Mediterranean diet pattern also reduced fasting glucose concentrations, cholesterol and triglyceride levels in patients.
• A sub-study of the larger PREDIMED trial, in the Journal of Neurology, Neurosurgery & Psychiatry found that individuals randomly assigned to a Mediterranean diet had better cognitive function than control patients who followed a low-fat diet.
• A significant reduction in the development of hardening of the arteries (measured in the carotid arteries).
• Improved mental function (less dementia).
• Reduced heart attacks, stroke and halved new-onset type 2 diabetes for those on the Mediterranean dietary pattern.

Swedish study on lifestyle

Eating a minimally processed diet (ie: real food) rich in healthy amounts of fruits and vegetables, legumes, whole grain, fish, nuts, and low-fat dairy has been shown in many studies to be associated with significant reduction of major cardiac events such as heart attacks and strokes. This is important to all of us since cardiovascular problems are the major cause of death and disability for most Americans. A recent study from Sweden showed a dramatic impact adopting a healthy lifestyle had on preventing one’s first heart attack. Nearly 21,000 middle-aged and older Swedish men who maintained 5-health promoting behaviors:

1. no smoking
2. moderate alcohol consumption
3. regular exercise
4. kept weight goals
5. consumed a healthy dietary pattern

lowered their risk of a future heart attack over an average 11-year period by a whopping 86%!  The low-risk healthy diet was one that encouraged more fruits and vegetables, reduced-processed foods and dairy, and more whole grains, and fish. This is a nutrition pattern endorsed by the American Heart Association’s 2020 impact goal and is the foundation for maintaining health and importantly.

In this study the group of men who maintained only a heart healthy diet and moderate alcohol consumption only still had as much as a 35% lower heart attack risk. That even exceeds the heart attack risk reduction seen by many statin drugs.

(A, Larsson SC, et al. Low-risk diet and lifestyle habits in the primary prevention of myocardial infarction in men. J Am Coll Cardiol 2014).

Vegetarian diet

According to the American Dietetic Association a vegetarian diet is defined as one that does not include meat or seafood, or products containing those foods.  There are different types of vegetarians. A vegetarian diet may be nutritionally adequate when well balanced and perhaps supplemented with fortified foods and vitamins if necessary.  Long-term, large population studies or randomized control studies are limited but lowering of various known cardiovascular risk factors have been found. Research shows benefits in cardiovascular health are associated with a vegetarian diet. But research also shows that a healthy dietary pattern may include animal-based products. A balanced dietary pattern is the key and best summarized  by Michael Pollen in the following quote:

“Eat food. Not too much. Mostly plants.”

Features of a vegetarian diet that may reduce risk of chronic disease include lower intakes of saturated fat and cholesterol and higher intakes of fruits, vegetables, whole grains, nuts, soy products, fiber, and phytochemicals. (J Am Diet Assoc. 2009;109:1266-1282).

Learn more:

The MIND: A Terrible Thing to Waste

Meat and Paleo

More Fruits and Vegetables

Healthy Aging and the Mediterranean Dietary Pattern

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