Nutrition
Nutrition Guidelines
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Nutrition Guidelines
, Food Pyramid, Healthy Diet
See Also
Nutrition for Athletes
Mediterranean Diet
Guideline
Choose food predominately from plant sources
Eat 5 or more servings of fruit or vegetable per day
Recommendations
One serving Fruit equivalents
One medium apple, banana, or orange
Chopped, cooked, or canned fruit (1/2 cup)
Fruit juice (3/4 cup)
One serving Vegetable equivalents
Raw leafy vegetables (1 Cup)
Cooked, chopped or raw vegetables (1/2 Cup)
Vegetable juice (3/4 Cup)
Benefits of Fruits and Vegetables
Decreased risk of
Colon Cancer
Decreased risk of
Gastric Cancer
Eat other foods from plant sources
Recommendations
One serving Whole Grains/Cereal/Pasta
Whole wheat Bread (1 slice)
Ready to eat cereal (1 ounce)
Cooked whole grain cereal, rice or pasta (1/2 cup)
One serving Beans and Nuts
Cooked dry beans (1/2 cup) preferred over nuts
Peanut butter (2 tablespoons)
Nuts (1/3 cup)
Benefits of
Dietary Fiber
Decreased risk of
Colon Cancer
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
However, over emphasis on fat-free at the expense of excessive carbohydrates results in weight gain
Do not trade fat for high carbohydrate, increased calorie meals
Monounsaturated fats (e.g. olive oil) are a part of a Healthy Diet
Recommendations
Replace fatty foods
Eat fruits, vegetables, grains and beans
Eat smaller portions
Select non-fat/low-fat milk and dairy products (and overall limit to 1-2 servings per day)
When eating prepared foods, choose lower saturated fat
Limit consumption of meats (especially high fat meat)
Recommendations: 1 serving of meat per day
Lean meat (2-3 ounces)
Poultry (2-3 ounces)
Fish (2-3 ounces)
Gene
ral
Select lean cuts, and smaller portions of meat
Choose beans, seafood and poultry
Instead OF beef, pork and lamb
Select baked and broiled meats
Instead of fried, charcoal-broiled, or smoked
Risks of Salt-cured, pickled, or smoked meats
Esophageal Cancer
Gastric Cancer
Guideline
Healthy Eating Plate (Harvard, modified version of ChooseMyPlate.org)
Key Components
Vegetables and fruits (50% of the plate)
Whole grains (25% of plate)
Healthy protein such as legumes/beans or healthy animal protein (25% of plate)
Limited items
Limit butter, saturated fats and avoid trans fats
Use healthy oils (e.g. olive oil, canola oil)
Small handful of nuts
Limit milk/dairy (1-2/day), juice (1/day) and avoid sugar drinks (e.g. soda)
Primary beverage is water
May also use tea, coffee with little sugar or non-nutritive sweatener (e.g.
Sucralose
,
Aspartame
)
Limit salt
Limit to 2300 mg/day (1 tsp), and some guidelines recommend 1500 mg/day (2/3 tsp)
References
Harvard Nutrition Source
https://www.hsph.harvard.edu/nutritionsource/healthy-eating-plate/
Guideline
USDA Standard Food Pyramid (replaced by other meal planning strategies)
Precautions
Consider the Healthy Eating Plate above as an alternative
USDA Food Pyramid is influenced by many outside forces including the meat and dairy industry
Based on Scientific Report of Dietary Guidelines Advisory Committee, released every 5 years
However, USDA breaks with advisory board when in political conflict (e.g. meat/dairy, environment)
Fiber
: 6 to 11 servings per day
Bread
Cereal
Rice or Pasta
Vegetables: 3-5 servings/day
Fruits: 2-4 servings/day
Dairy: 2 to 3 servings per day
Milk
Yogurt
Cheese
Protein: 2-3 servings per day
Meat
Poultry
Fish
Dry beans
Eggs
Nuts
Fats, oils, and sweets
Used only sparingly
Guideline
Miscellaneous
Be physically active and maintain a healthy weight
Moderate activity for 30 minutes on most days
Maintain a body weight within 20% of ideal
Limit
Alcohol
ic beverages
Alcohol
, when used in moderation may be a part of a healthy lifestyle
However, encouraging
Alcohol
use in those who use little to no
Alcohol
, risks
Alcohol Abuse
Those who safely use
Alcohol
in moderation may continue
Risks associated with longterm heavy
Alcohol
use or abuse
Oropharyngeal cancer
Esophageal Cancer
Hepatocellular Carcinoma
Breast Cancer
Pearls
Avoid products that raise the risk of excess calories, weight gain,
Diabetes Mellitus
Avoid sugar-containing soft drinks
Cereal grains (wheat, rye, barley, corn, rice, oats, millet) and pseudo-grains (quinoa, amaranth)
Whole grains are preferred
Whole grains mill all three grain components (bran, germ, endosperm) together
Refined grains contain only the milled endosperm (germ and bran are removed)
Wet grains are preferred over dried grains (from a nutritional, excess calorie standpoint)
Cooked oatmeal is more filling initially than dried cereals
Dietary Fat
Use healthier oils high in monounsaturated fat (olive oil, saflower oil, canola oil, peanut oil)
Avoid unhealthy, tropical oils (coconut oil, palm oil) that are 86-92% saturated fat
Decrease in saturated fat and trans fat lowers coronary risk
Unsaturated fats in moderation are considered a part of a Healthy Diet
Over emphasis on fat-free at the expense of excessive carbohydrates results in weight gain
Replacing unsaturated
Dietary Fat
with refined starch and sugar results in worse outcomes
Dairy
Vitamin D
is more likely than calcium to be deficient
Most people in the U.S. (esp. northern climates) could benefit from 1000 IU/day
Vitamin D
Calcium intake is sufficient with 3 servings per day
High calcium intake increases
Prostate Cancer
risk
Plant-based food focus (plant forward)
See Below
Eat less meat (esp. less red meat)
Replace red meat with nuts, legumes, fish and poultry
High
Temperature
cooking (e.g. barbeque, open flame) of meat or poultry is associated with Diabetes risk
Liu (2017) Diabetes Care 40(8):1041-9 +PMID: 28611054 [PubMed]
Logistics and social factors
For those who have too little time to practice a healthy lifestyle
If you do not have time to be sick, you must take time to be well
Make media-free, family dinners a habit
Set out a plate of cut vegetables for snacking while preparing dinner
Have lunch containers open to prepare at same time while making dinner
Many of the dinner items can be placed directly into lunch containers
Make time to eat breakfast (high quality with fiber and nutrients)
Breakfast skipping increases the risk of
Type 2 Diabetes Mellitus
,
Obesity
, Coronary Disease
Bi (2015) Public Health Nutr 18(16):3013-9 +PMID:25686619 [PubMed]
Produce shopping and storage
Buy max of only 2 weeks of perishables, wash, trim and store in humidified refrigerator door
Choose recipes in advance of shopping and stick to a shopping list
Choose recipes that share core ingredients, may be prepped in advance, and good as left-overs
Keep salad greens and herbs wrapped in damp towel or in a container with water at bottom
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
Maximal medical management for cardiovascular disease has reached a mortality plateau (2010)
Further advances in lowering cardiovascular mortality will need to maximize healthy lifestyle
"Greatest advances... offset by the burden... caused by too many people eating too much... moving too little"
(2005) Institute of Medicine +PMID:22379642
Children are not compelled to relive their parent's medical history ("genes are not destiny")
High genetic risk patients with healthy lifestyle lowered their coronary event risk by 46%
Khera (2016) N Engl J Med 375:2349-58 [PubMed]
Since 1994,
Obesity
(BMI>30 kg/m2) has dramatically increased throughout the U.S
As of 2015, most U.S. states have more than 26%
Obesity
rates (contrast with <14-18% in 1994)
As of 2014,
Type II Diabetes Mellitus
Prevalence
in the U.S. has increased to 22% (contrast with 5% in 1980)
Up to 60% of U.S, toddlers in 2017 are projected to be obese by age 35 years old
Ward (2017) N Engl J Med 377:2145-53 [PubMed]
Food insecurity and hunger
Associated with increased hospitalizations and worse comorbidity management
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
In the U.S., even those on plant based diets far exceed protein requirements (0.8 g/kg or 40-60 g/day)
Most in U.S. consume >70 g/day, and on average >90 g/day
Even for other countries with high protein intake (Europe), plant-based protein is more prevalent
Agriculture (esp. live stock) is the world's second largest emitter of greenhouse gases (behind energy)
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)
"Delicious, unapologetic, cravable" recipes making use of mediterranean, asian and latin flavors
Maximize the use of local produce
Meat in smaller amounts (2 ounce), less frequently overall (protein-flip: meat becomes the side-dish)
More seafood (diverse selection) than poultry/eggs than red meat
Replace red meat with nuts, legumes, fish and poultry
Blended burgers (meat mixed with mushrooms, grains, vegetables, legumes)
Meat becomes the dish condiment or seasoning
Resources
Menus of Change
http://www.menusofchange.org/
Plant Forward 50 (chefs and restaurants)
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
Chef knife, pairing knife, cutting board, vegetable peeler, can opener
Measuring spoons and cups, whisk, slotted spoon, colander/strainer, mixing bowls
Stock pot with lid (5 qt)
Saute pan (11")
Sheet pan and cooling rack
Minimal home pantry
Flour (whole wheat, unbleached all-purpose), Brown rice, rolled oats, grains (e.g. quinoa), whole wheat pasta
Nuts (e.g. almonds), dried fruit (e.g. raisins), dried beans (e.g. lentils, black beans, split peas)
Oils (olive, canola), Vinegar (wine, rice or apple), mustard, honey
Kosher salt, black pepper
Flavor foods by cuisine
Asian
Light soy sauce, fish sauce, rice vinegar, sesame oil, chili
Garlic
sauce
Garlic
,
Ginger
, lemon grass, lime, chilles, cilantro, Tofu, scallions
Cumin, coriander, cinnamon
Mediterranean
Olive oil, balsamic, red wine vinegar
Garlic
, tomato, olives, onions
Parmesan, feta, capers, basil, thyme, oregano, parsley
Latin America
Tortillas, lime, chiles (serano, jalapeno, chipolte), cilantro,
Garlic
Rice, beans, corn, avocado, tomatillo, onions, cheese
Workspace organization ("Mise en Place")
Back row
Tray for ingredients and prep bowls
Large scrap bowl (and consider bags for freezing stock)
Front row
Cutting board, knives, spices/oils
Resources
Healthy Eating Plate (Harvard)
https://www.hsph.harvard.edu/nutritionsource/healthy-eating-plate/
Choose My Plate
http://www.choosemyplate.gov/
Healthy Kitchens, Healthy Lives Conference, Harvard and CIA, St. Helena, CA
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]
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