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What Should You
Really Eat?
HARVARD
SCHOOL OF PUBLIC HEALTH
More than a decade ago, the U.S. Department of
Agriculture created a powerful and enduring icon - the Food Guide
Pyramid. This simple illustration conveyed in a flash what the USDA
said were the elements of a healthy diet. The Pyramid was taught in
schools, appeared in countless media articles and brochures, and was
plastered on cereal boxes and food labels.
Tragically, the information embodied in this
pyramid didn't point the way to healthy eating. Why not? Its
blueprint was based on shaky scientific evidence, and it barely
changed over the years to reflect major advances in our
understanding of the connection between diet and health.
With much fanfare, the USDA recently retired the
old Food Guide Pyramid and replaced it with MyPyramid, a new symbol
and "interactive food
guidance system." The new symbol is basically the old
Pyramid turned on its side.
The good news is that this dismantles and buries
the flawed Pyramid. The bad news is that the new symbol doesn't
convey enough information to help you make informed choices about
your diet and long-term health. And it continues to recommend foods
that aren't essential to good health, and may even be detrimental in
the quantities included in MyPyramid.
As an alternative to the USDA's flawed pyramid,
faculty members in the Harvard School of Public Health built the
Healthy Eating Pyramid. It resembles the USDA's in shape only. The
Healthy Eating Pyramid takes into consideration, and puts into
perspective, the wealth of research conducted during the last ten
years that has reshaped the definition of healthy eating.
Pyramid
Building
In the children's book Who Built the Pyramid?,(1)
different people take credit for building the once-grand pyramid of
Senwosret. King Senwosret, of course, claims the honor. But so does
his architect, the quarry master, the stonecutters, slaves, and the
boys who carried water to the workers.
The USDA's MyPyramid also had many builders. Some
are obvious - USDA scientists, nutrition experts, staff members, and
consultants. Others aren't. Intense lobbying efforts from a variety
of food industries also helped shape the pyramid.
In theory, the USDA pyramid should reflect the
nutrition advice assembled in the Dietary
Guidelines for Americans. According to the USDA, the guidelines
"provide authoritative advice for people two years and older
about how good dietary habits can promote health and reduce risk for
major chronic diseases."
This document, which by law must be revised every
five years, aims to offer sound nutrition advice that corresponds to
the latest scientific research. The panel assembled to create the
guidelines usually generates 100 or so pages of dense
nutrition-speak. This document is translated into a reader
friendly brochure aimed at helping the average person choose a
balanced and healthy diet. Of far greater importance, the Dietary
Guidelines for Americans set the standards for all federal nutrition
programs, including the school lunch program, and helps determine
what food products Americans buy. In other words, the guidelines
influence how billions of dollars are spent each year. So even minor
changes can hurt or help a food industry.
According to federal regulations, the panel that
writes the dietary guidelines must include nutrition experts who are
leaders in pediatrics, obesity, cardiovascular disease, and public
health. Selecting the panelists is no easy task, and is subject to
intense lobbying from organizations such as the National Dairy
Council, United Fresh Fruit and Vegetable Association, Soft Drink
Association, American Meat Institute, National Cattlemen's Beef
Association, and Wheat Foods Council.(2)
(We have the best government that money can buy, and they are soooo
objective. HUGE money has been spent to influence this government
release. Your health is the last thing to be considered. God forbid
that an official source would say that drinking soda pop, eating red
meat, drinking milk, etc. is bad for your health.)
Dietary
Guidelines, 2005
Released in early January, 2005, the Dietary
Guidelines for Americans 2005 continues to reflect the tense
interplay of science and the powerful food industry. Several of the
new recommendations represent important steps in the right
direction:
| The new guidelines emphasize the importance of
controlling weight, which was not adequately addressed in
previous versions. And they continue to stress the importance of
physical activity.
| The recommendation on dietary fats makes a
clear break from the past, when all fats were considered bad.
The guidelines now emphasize that intake of trans fats should be
as low as possible and that saturated fat should be limited.
There is no longer an artificially low cap on fat intake. The
latest advice recommends getting between 20% and 35% of daily
calories from fats and recognizes the potential health benefits
of monounsaturated and polyunsaturated fats.
| Instead of emphasizing "complex
carbohydrates," a term used in the past that has little
biological meaning, the new guidelines urge Americans to limit
sugar intake and they stress the benefits of whole grains. |
| |
Others remain mired in the past:
| The guidelines suggest that it is fine to
consume half of our grains as refined starch. That's a shame,
since refined starches behave like sugar. They add empty
calories, have adverse metabolic effects, and increase the risks
of diabetes and heart disease.
| In terms of protein, the guidelines continue to
lump together red meat, poultry, fish, and beans (including soy
products). They ask us to judge these protein sources by their
total fat content, "make choices that are lean, low-fat, or
fat-free." This ignores the evidence that these foods have
different types of fats. It also overlooks mounting evidence
that replacing red meat with a combination of fish, poultry,
beans, and nuts offers numerous health benefits.
| The recommendation to drink three glasses of
low-fat milk or eat three servings of other dairy products per
day to prevent osteoporosis is another step in the wrong
direction. Of all the recommendations, this one represents the
most radical change from current dietary patterns. Three glasses
of low-fat milk add more than 300 calories a day. This is a real
issue for the millions of Americans who are trying to control
their weight. What's more, millions of Americans are lactose
intolerant, and even small amounts of milk or dairy products
give them stomachaches, gas, or other problems. This
recommendation ignores the lack of evidence for a link between
consumption of dairy products and prevention of osteoporosis. It
also ignores the possible increases
in risk of ovarian cancer and prostate cancer associated
with dairy products. |
| |
The USDA
Pyramid Brick by Brick
Distilling nutrition advice into a pyramid was a
stroke of genius. The shape immediately suggests that some foods are
good and should be eaten often, and that others aren't so good and
should be eaten only occasionally. The layers represent major food
groups that contribute to the total diet. MyPyramid tries to do this
in an abstract way, and fails.
Six swaths of color sweep from the apex of
MyPyramid to the base: orange for grains, green for vegetables, red
for fruits, a teeny band of yellow for oils, blue for milk, and
purple for meat and beans. Each stripe starts out as the same size,
but they don't end that way at the base. The widths suggest how much
food a person should choose from each group. A band of stairs
running up the side of the Pyramid, with a little stick figure
chugging up it, serves as a reminder of the importance of physical
activity.
MyPyramid contains no text. According to the USDA,
it was "designed to be simple," and details are at MyPyramid.gov.
Unless you've taken the time to become familiar with the Pyramid,
though, you have no idea what it means. Relying on the Web site to
provide key information - like what the color stripes stand for and
how many servings of each food group are recommended each day -
guarantees that the millions of Americans without access to a
computer or the Internet will have trouble getting these essential
facts.
The USDA also chose not to put recommended numbers
of servings on the new Pyramid because these differ from individual
to individual according to weight, gender, activity level and age.
Instead, it offers personalized Pyramids at MyPyramid.gov.
Building
a Better Pyramid
If the only goal of the Food Guide Pyramid is to
give us the best possible advice for healthy eating, then it should
be grounded in the evidence and be independent of business.
Instead of waiting for this to happen, nutrition
experts from the Harvard School of Public Health created the Healthy
Eating Pyramid. It is based on the best available scientific
evidence about the links between diet and health. This new pyramid
fixes fundamental flaws in the USDA pyramid and offers sound
information to help people make better choices about what to eat.
From EAT,
DRINK, AND BE HEALTHY by Walter C. Willett, M.D. Copyright ©
2001, 2005 by the President and Fellows of Harvard College.
Reprinted by permission of Free Press/Simon & Schuster, Inc.
The Healthy Eating Pyramid sits on a foundation of
daily exercise and weight control. Why? These two related elements
strongly influence your chances of staying healthy. They also affect
what and how you eat and how your food affects you. The other bricks
of the Healthy Eating Pyramid include:
| Whole Grain Foods (at
most meals). The body needs carbohydrates
mainly for energy. The best sources of carbohydrates are whole
grains such as oatmeal, whole-wheat bread, and brown rice. They
deliver the outer (bran) and inner (germ) layers along with
energy-rich starch. The body can't digest whole grains as
quickly as it can highly processed carbohydrates such as white
flour. This keeps blood sugar and insulin levels from rising,
then falling, too quickly. Better control of blood sugar and
insulin can keep hunger at bay and may prevent the development
of type
2 diabetes. (These are low glycemic foods. Your body runs on
carbs. You can not avoid eating carbs and stay healthy. It is
not carbs as a whole that cause weight gain. It is high glycemic
carbs. See Glycemic Index.)
| Plant Oils.
Surprised that the Healthy Eating Pyramid puts some fats
near the base, indicating they are okay to eat? Although this
recommendation seems to go against conventional wisdom, it's
exactly in line with the evidence and with common eating habits.
The average American gets one third or more of his or her daily
calories from fats, so placing them near the foundation of the
pyramid makes sense. Note, though, that it specifically mentions
plant oils, not all types of fat. Good sources of healthy
unsaturated fats include olive, canola, soy, corn, sunflower,
peanut, and other vegetable oils, as well as fatty fish such as
salmon. These healthy fats not only improve cholesterol levels
(when eaten in place of highly processed carbohydrates) but can
also protect the heart from sudden and potentially deadly rhythm
problems.(3) (AVOID TRANS-FATS!! Seek
out healthy fats.)
| Vegetables (in
abundance) and Fruits (2 to 3 times). A diet rich in fruits
and vegetables can decrease the chances of having a heart
attack or stroke; protect against a variety of cancers; lower
blood pressure; help you avoid the painful intestinal ailment
called diverticulitis; guard against cataract and macular
degeneration, the major cause of vision loss among people over
age 65; and add variety to your diet and wake up your palate.
(Vegetables are a source of minerals and vitamins (antioxidants)
and should be included in every meal. Fruits are best consumed
by themselves preferably on an empty stomach the first thing in
the morning about a half hour before you eat a normal breakfast.
Be aware that today's veggies do not contain a fraction of the
nutrients found there 20-30 years ago. So add to your meals with
a quality multi-supplement.)
| Fish, Poultry, and
Eggs (0 to 2 times). These are important sources of protein.
A wealth of research suggests that eating fish can reduce the
risk of heart disease. Chicken and turkey are also good sources
of protein and can be low in saturated fat. Eggs, which have
long been demonized because they contain fairly high levels of
cholesterol, aren't as bad as they're cracked up to be. In fact,
an egg is a much better breakfast than a doughnut cooked in an
oil rich in trans fats or a bagel made from refined flour.
| Nuts and Legumes (1 to
3 times). Nuts and legumes are excellent sources of
protein, fiber, vitamins, and minerals. Legumes include black
beans, navy beans, garbanzos, and other beans that are usually
sold dried. Many kinds of nuts contain healthy fats, and
packages of some varieties (almonds, walnuts, pecans, peanuts,
hazelnuts, and pistachios) can now even carry a label saying
they're good for your heart. (Notice that peanuts are not listed
here. Peanuts are a combination of things that make it difficult
for you to digest well and should be eaten sparingly.)
| Dairy or Calcium
Supplement (1 to 2 times). Building bone and keeping
it strong takes calcium,
vitamin D, exercise, and a whole lot more. Dairy products have
traditionally been Americans' main source of calcium. But there
are other healthy ways to get calcium than from milk and cheese,
which can contain a lot of saturated fat. Three glasses of whole
milk, for example, contains as much saturated fat as 13 strips
of cooked bacon. If you enjoy dairy foods, try to stick with
no-fat or low-fat products. If you don't like dairy products,
calcium supplements offer an easy and inexpensive way to get
your daily
calcium. (We subscribe to the theory that adults can not
digest milk products. We are the only species that consumes milk
after babyhood. You can get calcium from other sources in
addition to supplements but you should use a quality supplement
with Vitamin D. Also studies have raised a lot of questions
about consuming pasturized milk products. Do some reading and
don't assume just because the milk industry spends a lot of
money to convince you to drink milk that it actually is actually good for
you. That could be a very good reason to suspect it.)
| Red Meat and Butter
(Use Sparingly): These sit at the top of the Healthy
Eating Pyramid because they contain lots of saturated fat. If
you eat red meat every day, switching to fish or chicken several
times a week can improve cholesterol levels. So can switching
from butter to olive oil. (You don't have to be a vegetarian but
it is not healthy to eat red meat, period. Teach your children
this so they will not have to suffer your fate when they get
older. Olive oil is very good for you. It is a powerful
antioxidant and great food.)
| White Rice, White
Bread, Potatoes, White Pasta, Soda, and Sweets (Use Sparingly):
Why are these all-American staples at the top, rather than the
bottom, of the Healthy Eating Pyramid? They can cause fast and
furious increases in blood sugar that can lead to weight gain,
diabetes, heart disease, and other chronic disorders.
Whole-grain carbohydrates cause slower, steadier increases in
blood sugar that don't overwhelm the body's ability to handle
this much needed but potentially dangerous nutrient. (Read the
section here about high glycemic foods which is what is being
suggested by the prior paragraph.)
| Multiple Vitamin:
A daily multivitamin,
multimineral supplement offers a kind of nutritional backup.
While it can't in any way replace healthy eating, or make up for
unhealthy eating, it can fill in the nutrient holes that may
sometimes affect even the most careful eaters. You don't need an
expensive name-brand or designer vitamin. A standard,
store-brand, RDA-level one is fine. Look for one that meets the
requirements of the USP (U.S. Pharmacopeia), an organization
that sets standards for drugs and supplements. (The web page
authors disagree with this statement. Supplements are important
but just any vitamin off the shelf based on RDA (minimum daily
amounts) is far from correct. Any vitamin/supplement you take
should be pharmaceutical grade to guarantee the quality of the
product and the ingredients should be based on optimum amounts
not minimal of nutrients. You do get what you pay for or less
off the shelf. Read more about this in the supplement section.)
| Alcohol (in
moderation): Scores of studies suggest that having an
alcoholic drink a day lowers the risk of heart disease.
Moderation is clearly important, since alcohol has risks as well
as benefits. For men, a good balance point is 1 to 2 drinks a
day. For women, it's at most one drink a day. (Red wine is a
good source of antioxidants since the grape seeds are used in
the production of red wine. Of course wine should be drank in
moderation.) |
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Other
Alternatives
The Healthy Eating Pyramid summarizes the best
dietary information available today. It isn't set in stone, though,
because nutrition researchers will undoubtedly turn up new
information in the years ahead. The Healthy Eating Pyramid will
change to reflect important new evidence.
This isn't the only alternative to the USDA's
MyPyramid. The Asian, Latin, Mediterranean, and vegetarian pyramids
promoted by Oldways Preservation
and Exchange Trust are also good, evidence-based guides for
healthy eating. The Healthy Eating Pyramid takes advantage of even
more extensive research and offers a broader guide that is not based
on a specific culture. The Healthy Eating Pyramid is described in
greater detail in Eat, Drink, and Be Healthy: The Harvard Medical
School Guide to Healthy Eating, published by Simon and Schuster
(2001).
Failing The
Test
A few years ago, the USDA's Center for Nutrition
Policy and Promotion created the Healthy Eating Index "to
measure how well American diets conform to recommended healthy
eating patterns."(4) This score sheet
uses five elements from the longstanding USDA Food Guide Pyramid
(number of daily servings of grains, vegetables, fruits, meat, and
dairy products) and five from the 1995 Dietary Guidelines for
Americans (total fat in the diet, percentage of calories from
saturated fat, cholesterol intake, sodium intake, and variety of the
diet). A score of 100 means following the federal recommendations to
the letter while a score of 0 means totally ignoring them.
To see how well the principles embodied in the
Healthy Eating Pyramid stacked up against the government's advice,
Harvard School of Public Health researchers created an Alternate
Healthy Eating Index with a scoring system similar to the USDA's
index. They then used information about daily diets collected from
more than 100,000 female nurses and male health professionals taking
part in two long-term studies to complete both indexes.
Men who scored highest on the USDA's Healthy
Eating Index (meaning their diets most closely followed federal
recommendations) reduced their overall risk of developing heart
disease, cancer, or other chronic disease by 11% over 8-12 years of
follow-up compared to those who scored lowest. Women who most
closely followed the government's recommendations were only 3% less
likely to have developed a chronic disease.(5)
In comparison, scores on the Alternate Healthy
Eating Index did appear to correlate with disease. Men with high
scores (those whose diets most closely followed the guidelines in
the Healthy Eating Pyramid) were 20% less likely to have developed a
major chronic disease than those with low scores. Women with high
scores lowered their overall risk by 11%. Men whose diets most
closely followed the Healthy Eating Pyramid lowered their risk of
cardiovascular disease by almost 40%; women with high scores lowered
their risk by almost 30%.
"The new USDA dietary pyramid is a lost
opportunity to help Americans make informed choices about diet and
long-term health," says Walter Willett, the Fredrick John Stare
Professor of Epidemiology and Nutrition in the Departments of
Nutrition and Epidemiology. "It's clear that we need to rebuild
the pyramid from the ground up, not just tip it on its side and
dress it up with new colors. Every American deserves it."
References
1. Hooper M, Heighway-Bury R. Who Built the
Pyramid? Cambridge, Mass.: Candlewick Press, 2001.
2. Abboud L. Expect a food fight as U.S. sets to revise diet
guidelines. Wall Street Journal: August 8, 2003, B1
3. Leaf A, Kang JX, Xiao YF, Billman GE. Clinical prevention of
sudden cardiac death by n-3 polyunsaturated fatty acids and
mechanism of prevention of arrhythmias by n-3 fish oils. Circulation
2003; 107:2646-52.
4. The Healthy Eating Index. USDA Center for Nutrition Policy and
Promotion. http://warp.nal.usda.gov/fnic/HEI/hlthyeat.pdf
accessed on 13 December 1999.
5. McCullough ML, Feskanich D, Stampfer MJ, et al. Diet quality and
major chronic disease risk in men and women: moving toward improved
dietary guidance. Am
J Clin Nutr 2002; 76:1261-71.
HARVARD
SCHOOL OF PUBLIC HEALTH
2007
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