Nutrition Guidelines

See Also

Guideline
Choose food predominately from plant sources

Eat 5 or more servings of fruit or vegetable per day
1. Recommendations
  1. One serving Fruit equivalents
    1. One medium apple, banana, or orange
    2. Chopped, cooked, or canned fruit (1/2 cup)
    3. Fruit juice (3/4 cup)
  2. One serving Vegetable equivalents
    1. Raw leafy vegetables (1 Cup)
    2. Cooked, chopped or raw vegetables (1/2 Cup)
    3. Vegetable juice (3/4 Cup)
2. Benefits of Fruits and Vegetables
  1. Decreased risk of Colon Cancer
  2. Decreased risk of Gastric Cancer
Eat other foods from plant sources
1. Recommendations
  1. One serving Whole Grains/Cereal/Pasta
    1. Whole wheat Bread (1 slice)
    2. Ready to eat cereal (1 ounce)
    3. Cooked whole grain cereal, rice or pasta (1/2 cup)
  2. One serving Beans and Nuts
    1. Cooked dry beans (1/2 cup) preferred over nuts
    2. Peanut butter (2 tablespoons)
    3. Nuts (1/3 cup)
2. Benefits of Dietary Fiber
  1. Decreased risk of Colon Cancer
  2. Water insoluble (wheat bran) fiber may be better

Guideline
Limit intake of high fat foods (especially animal fat, saturated fat and trans fat)

Choose foods lower in fat
1. However, over emphasis on fat-free at the expense of excessive carbohydrates results in weight gain
  1. Do not trade fat for high carbohydrate, increased calorie meals
  2. Monounsaturated fats (e.g. olive oil) are a part of a Healthy Diet
2. Recommendations
  1. Replace fatty foods
  2. Eat fruits, vegetables, grains and beans
  3. Eat smaller portions
  4. Select non-fat/low-fat milk and dairy products (and overall limit to 1-2 servings per day)
  5. When eating prepared foods, choose lower saturated fat
Limit consumption of meats (especially high fat meat)
1. Recommendations: 1 serving of meat per day
  1. Lean meat (2-3 ounces)
  2. Poultry (2-3 ounces)
  3. Fish (2-3 ounces)
2. General
  1. Select lean cuts, and smaller portions of meat
  2. Choose beans, seafood and poultry
    1. Instead OF beef, pork and lamb
  3. Select baked and broiled meats
    1. Instead of fried, charcoal-broiled, or smoked
3. Risks of Salt-cured, pickled, or smoked meats
  1. Esophageal Cancer
  2. Gastric Cancer

Guideline
Healthy Eating Plate (Harvard, modified version of ChooseMyPlate.org)

Key Components
1. Vegetables and fruits (50% of the plate)
2. Whole grains (25% of plate)
3. Healthy protein such as legumes/beans or healthy animal protein (25% of plate)
Limited items
1. Limit butter, saturated fats and avoid trans fats
  1. Use healthy oils (e.g. olive oil, canola oil)
  2. Small handful of nuts
2. Limit milk/dairy (1-2/day), juice (1/day) and avoid sugar drinks (e.g. soda)
  1. Primary beverage is water
  2. May also use tea, coffee with little sugar or non-nutritive sweatener (e.g. Sucralose, Aspartame)
3. Limit salt
  1. Limit to 2300 mg/day (1 tsp), and some guidelines recommend 1500 mg/day (2/3 tsp)
References
1. Harvard Nutrition Source
  1. https://www.hsph.harvard.edu/nutritionsource/healthy-eating-plate/

Guideline
USDA Standard Food Pyramid (replaced by other meal planning strategies)

Precautions
1. Consider the Healthy Eating Plate above as an alternative
2. USDA Food Pyramid is influenced by many outside forces including the meat and dairy industry
  1. Based on Scientific Report of Dietary Guidelines Advisory Committee, released every 5 years
  2. However, USDA breaks with advisory board when in political conflict (e.g. meat/dairy, environment)
Fiber: 6 to 11 servings per day
1. Bread
2. Cereal
3. Rice or Pasta
Vegetables: 3-5 servings/day
Fruits: 2-4 servings/day
Dairy: 2 to 3 servings per day
1. Milk
2. Yogurt
3. Cheese
Protein: 2-3 servings per day
1. Meat
2. Poultry
3. Fish
4. Dry beans
5. Eggs
6. Nuts
Fats, oils, and sweets
1. Used only sparingly

Guideline
Miscellaneous

Be physically active and maintain a healthy weight
1. Moderate activity for 30 minutes on most days
2. Maintain a body weight within 20% of ideal
Limit Alcoholic beverages
1. Alcohol, when used in moderation may be a part of a healthy lifestyle
  1. However, encouraging Alcohol use in those who use little to no Alcohol, risks Alcohol Abuse
  2. Those who safely use Alcohol in moderation may continue
2. Risks associated with longterm heavy Alcohol use or abuse
  1. Oropharyngeal cancer
  2. Esophageal Cancer
  3. Hepatocellular Carcinoma
  4. Breast Cancer

Pearls

Avoid products that raise the risk of excess calories, weight gain, Diabetes Mellitus
1. Avoid sugar-containing soft drinks
Cereal grains (wheat, rye, barley, corn, rice, oats, millet) and pseudo-grains (quinoa, amaranth)
1. Whole grains are preferred
  1. Whole grains mill all three grain components (bran, germ, endosperm) together
  2. Refined grains contain only the milled endosperm (germ and bran are removed)
2. Wet grains are preferred over dried grains (from a nutritional, excess calorie standpoint)
  1. Cooked oatmeal is more filling initially than dried cereals
Dietary Fat
1. Use healthier oils high in monounsaturated fat (olive oil, saflower oil, canola oil, peanut oil)
  1. Avoid unhealthy, tropical oils (coconut oil, palm oil) that are 86-92% saturated fat
2. Decrease in saturated fat and trans fat lowers coronary risk
3. Unsaturated fats in moderation are considered a part of a Healthy Diet
  1. Over emphasis on fat-free at the expense of excessive carbohydrates results in weight gain
  2. Replacing unsaturated Dietary Fat with refined starch and sugar results in worse outcomes
Dairy
1. Vitamin D is more likely than Calcium to be deficient
  1. Most people in the U.S. (esp. northern climates) could benefit from 1000 IU/day Vitamin D
2. Calcium intake is sufficient with 3 servings per day
  1. High Calcium intake increases Prostate Cancer risk
Plant-based food focus (plant forward)
1. See Below
Eat less meat (esp. less red meat)
1. Replace red meat with nuts, legumes, fish and poultry
2. High Temperature cooking (e.g. barbeque, open flame) of meat or poultry is associated with Diabetes risk
  1. Liu (2017) Diabetes Care 40(8):1041-9 +PMID: 28611054 [PubMed]
Logistics and social factors
1. For those who have too little time to practice a healthy lifestyle
  1. If you do not have time to be sick, you must take time to be well
2. Make media-free, family dinners a habit
  1. Set out a plate of cut vegetables for snacking while preparing dinner
3. Have lunch containers open to prepare at same time while making dinner
  1. Many of the dinner items can be placed directly into lunch containers
4. Make time to eat breakfast (high quality with fiber and nutrients)
  1. Breakfast skipping increases the risk of Type 2 Diabetes Mellitus, Obesity, Coronary Disease
  2. Bi (2015) Public Health Nutr 18(16):3013-9 +PMID:25686619 [PubMed]
Produce shopping and storage
1. Buy max of only 2 weeks of perishables, wash, trim and store in humidified refrigerator door
2. Choose recipes in advance of shopping and stick to a shopping list
  1. Choose recipes that share core ingredients, may be prepped in advance, and good as left-overs
3. Keep salad greens and herbs wrapped in damp towel or in a container with water at bottom
4. Roast left over vegetables at the end of each week

Approach
Public Health and Prevention

Healthy Lifestyle is the keystone to reversing a U.S. trend of worsening overall health despite medical advances
1. Maximal medical management for cardiovascular disease has reached a mortality plateau (2010)
  1. Further advances in lowering cardiovascular mortality will need to maximize healthy lifestyle
2. "Greatest advances... offset by the burden... caused by too many people eating too much... moving too little"
  1. (2005) Institute of Medicine +PMID:22379642
Children are not compelled to relive their parent's medical history ("genes are not destiny")
1. High genetic risk patients with healthy lifestyle lowered their coronary event risk by 46%
  1. Khera (2016) N Engl J Med 375:2349-58 [PubMed]
Since 1994, Obesity (BMI>30 kg/m2) has dramatically increased throughout the U.S
1. As of 2015, most U.S. states have more than 26% Obesity rates (contrast with <14-18% in 1994)
2. As of 2014, Type II Diabetes Mellitus Prevalence in the U.S. has increased to 22% (contrast with 5% in 1980)
3. Up to 60% of U.S, toddlers in 2017 are projected to be obese by age 35 years old
  1. Ward (2017) N Engl J Med 377:2145-53 [PubMed]
Food insecurity and hunger
1. Associated with increased hospitalizations and worse comorbidity management
2. Most plant-based meals can be prepared for $1-3 per serving
Protein importance in the diet is over-stated at the expense of health, cost and the environment
1. In the U.S., even those on plant based diets far exceed protein requirements (0.8 g/kg or 40-60 g/day)
  1. Most in U.S. consume >70 g/day, and on average >90 g/day
  2. Even for other countries with high protein intake (Europe), plant-based protein is more prevalent
2. Agriculture (esp. live stock) is the world's second largest emitter of greenhouse gases (behind energy)
3. LIvestock are heavy resource utilizers (food, water); the same resources could support far more people directly

Approach
Restaurants - Menus of Change (Harvard, Culinary Institute of America)

Regionally sourced foods
Intact whole grains (minimal processing), nuts and legumes
Healthier oils (olive oil, saflower oil, canola oil, peanut oil)
Decrease the sugar and salt
Prepare more home meals (less eating-out at restaurants)
Plant-based food focus (plant forward)
1. "Delicious, unapologetic, cravable" recipes making use of mediterranean, asian and latin flavors
2. Maximize the use of local produce
Meat in smaller amounts (2 ounce), less frequently overall (protein-flip: meat becomes the side-dish)
1. More seafood (diverse selection) than poultry/eggs than red meat
  1. Replace red meat with nuts, legumes, fish and poultry
2. Blended burgers (meat mixed with mushrooms, grains, vegetables, legumes)
3. Meat becomes the dish condiment or seasoning
Resources
1. Menus of Change
  1. http://www.menusofchange.org/
2. Plant Forward 50 (chefs and restaurants)
  1. https://www.plantforward50.com/

Approach
Teaching Kitchens

Many health care organizations, teaching institutions and communities have built teaching kitchens
Offers hands-on education for delicious, healthy meal preparation for sustained habits
Minimal home kitchen kit
1. Chef knife, pairing knife, cutting board, vegetable peeler, can opener
2. Measuring spoons and cups, whisk, slotted spoon, colander/strainer, mixing bowls
3. Stock pot with lid (5 qt)
4. Saute pan (11")
5. Sheet pan and cooling rack
Minimal home pantry
1. Flour (whole wheat, unbleached all-purpose), Brown rice, rolled oats, grains (e.g. quinoa), whole wheat pasta
2. Nuts (e.g. almonds), dried fruit (e.g. raisins), dried beans (e.g. lentils, black beans, split peas)
3. Oils (olive, canola), Vinegar (wine, rice or apple), mustard, honey
4. Kosher salt, black pepper
Flavor foods by cuisine
1. Asian
  1. Light soy sauce, fish sauce, rice vinegar, sesame oil, chili Garlic sauce
  2. Garlic, Ginger, lemon grass, lime, chilles, cilantro, Tofu, scallions
  3. Cumin, coriander, cinnamon
2. Mediterranean
  1. Olive oil, balsamic, red wine vinegar
  2. Garlic, tomato, olives, onions
  3. Parmesan, feta, capers, basil, thyme, oregano, parsley
3. Latin America
  1. Tortillas, lime, chiles (serano, jalapeno, chipolte), cilantro, Garlic
  2. Rice, beans, corn, avocado, tomatillo, onions, cheese
Workspace organization ("Mise en Place")
1. Back row
  1. Tray for ingredients and prep bowls
  2. Large scrap bowl (and consider bags for freezing stock)
2. Front row
  1. Cutting board, knives, spices/oils

Resources

Healthy Eating Plate (Harvard)
1. https://www.hsph.harvard.edu/nutritionsource/healthy-eating-plate/
Choose My Plate
1. http://www.choosemyplate.gov/
Healthy Kitchens, Healthy Lives Conference, Harvard and CIA, St. Helena, CA
1. http://www.healthykitchens.org

Reference

Eisenberg, Willet, Clark, Hu (2018) Healthy Kitchens, Healthy Lives Conference, Harvard and CIA, St. Helena, CA
(1996) CA Cancer J Clin 46:325-341 [PubMed]