EATING WELL AND LOVING IT
The science of nutrition is exploding. Almost every day, new research is published showing how what you eat affects your health in specific ways. Good nutrition can promote a sense of well-being in both your body and mind. It can decrease your risk for most of the chronic conditions that we associate with growing older: weight gain, heart disease, high blood pressure, type 2 diabetes, arthritis, osteoporosis, various forms of cancer, and possibly even mental health disorders. And when you combine good nutrition with exercise, you have the most powerful medicine that's available for optimizing your health. A 1993 study of the causes of mortality published in the Journal of the American Medical Association estimates that more than 300,000 premature deaths-deaths that could have been prevented-occur each year because of poor nutrition and inactivity, a number second only to the 500,000 premature deaths caused each year by cigarette smoking.
The problem is that many nutritional-research findings are reported by the media without context, leading to confusion about the potential benefits and drawbacks of these discoveries. Because our knowledge is expanding so rapidly, and because different studies can produce contradictory results, what we've learned about nutrition in recent years has been obscured by controversy and misconceptions.
The confusion has been fueled by the government and public health community which have, for good reason, adjusted dietary recommendations in response to new research, and by the fad diets popularized by doctors with no training in nutrition. These individuals tend to focus on only one aspect of a food or food group and fail to bring the whole diet into context.
The problem for the public has been compounded by the proliferation of highly processed, convenient, high-calorie, palatable foods that are inexpensive and widely available. These foods are merchandised so aggressively that it is a daunting task to sort out what is healthy from what is not.
An example of where this all leads is the misunderstanding of fat. Fat is essential in the human diet. Our bodies need a certain amount of it in order to maintain our skin, immune system, muscles, hormone levels, reproduction, and other important functions. Nutritional research has also shown that several types of fats actually promote health. But by now, dietary fat of any kind has been linked to heart disease and obesity, among other health problems, for so long that a label with the words fat-free conveys the misleading subliminal message This is healthy food.
Many such foods are more detrimental to health than if they simply contained their original fat content. They have the same amount of calories, and because they are so high in refined sugar, they can cause a high blood glucose response.
EATING WELL TODAY FOR A
Good nutrition does not come from a pill. The healthiest diet you can eat comes from real foods, whole foods-foods that contain no artificial ingredients, or have not had beneficial substances removed, as refined grains have. Almost all the vitamins, minerals, phytochemicals, and fiber you need, to say nothing of the sheer pleasure of eating, are to be found in food. The best way to get all those nutrients, and get them in the right balance, is to eat a varied diet of whole foods.
It's tempting to think that you can get everything you need to stay healthy by popping a handful of supplements to take the place of the foods you have omitted from your diet, and by taking herbal remedies in pill form that presumably will improve your memory, help prevent colds, or allow you to sleep. Certainly, some supplements have an important role in promoting health, but they are not a substitute for good nutrition because they do not provide the long-term benefits to be had from all the compounds found in food.
Just recently I turned 40. I think of this as an achievement: the stature of early middle age. I'm focused on the here-and-now, on my family, and the way I feel today. But I never lose sight of the way I want to feel thirty or forty years from now, and even beyond that. When I look ahead, I think about my risks for chronic disease, and I know that the best way to grow old with vigor and independence is to pursue the course I'm on now: eating and exercising well, and loving it.
Sometimes it's hard to think about the future until it's there in front of you. But, if eating well can make you feel good right now-can make you look good as well-it will pay off in the future by helping you look and feel your best and by reducing your risk of chronic disease as you grow older.
I care about my health and my state of mind, and I know that most women care about themselves and their families in the same way. But because they are stretched to the limit with work, family, and other commitments, for many women, exercise and eating right are the first to go when time gets tight. In truth, it doesn't take much time to eat well. Knowledge and a little bit of planning can make a huge difference.
WHAT WE EAT IN AMERICA
In Chapter 11, "What's in Food Today?," I talk about the dramatic changes in our food supply that have occurred over the last 50 years. On the plus side of the ledger is the fact that although most of our food is no longer seasonal or locally grown, there are now far more fresh fruits and vegetables available to us year round than ever before. On the minus side, many thousands more processed, unhealthy food products now line our supermarket shelves, and these are the foods many of us choose to eat as a matter of course, as a matter of convenience, and as a matter of subtle persuasion by advertisers.
There have also been profound changes in the way we eat. Fifty years ago we ate family meals together without the television on; we actually ate most of our meals sitting down at a table rather than standing at a counter, at our desks, in the car, or on the run. Most of these changes are for the worse.
Since the 1930s, the U.S. government has been tracking what people eat, information that is important for policy formation, regulations, program planning, and evaluation and education. The National Nutrition Monitoring and Related Research Act of 1990 provides the mandate for large-scale monitoring of Americans' nutrition status and food consumption. I worked aggressively on this bill in 1988 while I was a legislative assistant to Senator Patrick Leahy of Vermont.
Over 16,000 people participate nationwide in the Continuing Survey of Food Intakes by Individuals, popularly known as the "What We Eat in America Survey," which includes more than just what we eat. This is what the most recent data, from 1996, show:
* More than one-half of adults are overweight.
* Forty-four percent of women say they rarely or never exercise vigorously, a number that has been increasing since the 1970s
About 57 percent of Americans eat at least one meal away from home on any given day, up from 43 percent in the 1970s. Foods eaten away from home in the mid-1990s accounted for more than 25 percent of total calories and fat intake.
* Women still fail to meet the requirements of several important nutrients: calcium, magnesium, and zinc, and vitamins E and B6.
* Fruit and vegetable consumption has remained stable over the last couple of decades, with only 55 percent of women even eating fruit or drinking fruit juice on a given day. The average fruit and vegetable consumption for women is 1.5 fruits per day and 3.3 vegetables, far short of what is optimal for good health.
* Grain consumption has risen. Between the late 1970s and the mid-1990s, sales of ready-to-eat cereal increased by 60 percent, and Americans' consumption of snacks such as crackers, popcorn, pretzels, and corn chips rose by 200 percent.
* Women don't eat enough dietary fiber. On average, women get 14 grams a day, when they should be eating 20 to 30 grams daily.
* In the 1970s, dietary fat accounted for about 40 percent of the calories in an average American diet. That number has decreased to an average of 33 percent. Nevertheless, that percentage is still too high, and only one-third of adults consumed 30 percent or less of their calories as fat, the figure recommended by nutrition experts (including myself).
* Among children, consumption of milk has decreased by 16 percent since the late 1970s, while the consumption of carbonated soft drinks has increased by 16 percent. Consumption of noncitrus drinks, including grape-, apple-, and other fruit-based mixtures, rose by 280 percent.
Among all the changes in the Continuing Survey that have occurred since the 1970s, four are of special interest and immediate concern. The first change is a good one: fat consumption has decreased. However, while we have made great gains in reducing fat intake, it has come with a price. In response to the health recommendation that fat is bad, many in the public now have a fear of fat. Numerous formerly fat-filled foods have been replaced by new "fat-free" items, which are chock-full of sugar, salt, additives, and (often) the same amount of calories as contained in the original foods. People think of these foods as healthy because they are low-fat, so they eat more of them. But calorie intake has not decreased along with the drop in fat consumption. Another problem is that many of these foods have high amounts of refined sugar, and they produce a high glycemic response (spiked glucose and insulin levels in the blood). Over time, eating these foods elevates risk for heart disease, type 2 diabetes, and obesity.
Second, grain consumption is up significantly. That might be a good thing if it were whole grains being eaten with such abandon. Unfortunately we are eating fewer whole grains, such as brown rice and whole-wheat bread, high-fiber carbohydrates that are digested slowly and satisfy hunger for longer periods of time. We are, however, consuming more snack foods, white rice, white pasta, ultra-sweet desserts, and highly processed breakfast cereals than before. These low-fiber, carbohydrate-rich foods are a quick fix for hunger, but because they are quickly digested they satisfy hunger for much shorter periods of time than whole grains. And to the detriment of our health, these foods also produce a high glycemic response.
The third alarming trend is the increasingly sedentary lifestyle of Americans, which has so many deleterious consequences for our health. Finally, the fourth change is the growing epidemic of obesity in America, which is the consequence of the first three trends. The epidemic is not just among adults but, even more worrisome, among our children.
Food supply gone awry
In the early 1950s, there were about 2,000 different food items on sale at the local grocery store. By the 1980s, that number had grown to 5,000 items, and today more than 40,000 different foods are being sold at the average supermarket, with about 60,000 or more in a superstore. Thirteen thousand new food products are introduced each year.
Few new varieties of apples or brown rice are being grown and marketed. The boom is in prepared meals, processed foods, sodas, snack bars, refined breakfast cereals, and other unwholesome foods. The good news is that because many more consumers are aware of good nutrition, they are demanding healthier food products. In response, some food manufacturers are developing and marketing healthier choices.
Shopping for food at a supermarket has become much more difficult. I admit that I have a certain nostalgia for the local grocery of my childhood. My mother and I knew the owner-he even bought a puppy from us. The store was about the size of most people's garages, with many fewer choices than there are today, and we could easily figure out which fresh foods we wanted for our meals. Now when I go to the supermarket with my children, it takes forever, and it's difficult navigating through the multitude of processed foods to find the few whole-food items that I need. In fact, there are so many products, so many labels to read, so many health factors to consider, that sometimes it's hard to grasp just how unhealthy a seemingly reasonable, time-saving choice may actually be.
The relentless merchandising of food products has changed the way we eat. Don't get me wrong. I love the fact that I can now buy freshly squeezed orange juice and kiwis as well as a variety of whole-grain cereals at the supermarket. It's just that these few amenities are overshadowed by a superabundance of tempting processed foods that do not promote health.
Restaurant meals: where's the real "value"?
"What We Eat in America," the survey described previously, shows that well over half of us eat at least one meal away from home on any given day. One third of those meals are from fast-food restaurants. Although fast food is notorious for being, on average, higher in fat-especially saturated fat-and lower in fiber and fruits and vegetables than home-cooked food, the same is true of almost any meal you eat in a restaurant.
It's not surprising that there is a strong relationship between frequency of eating in restaurants and obesity. It's not just because the food is higher in fat than it would be if you prepared it at home, it is because the portions are obscenely large. Fast-food restaurants are not the only offenders; other family restaurants and even more expensive ones are serving just as much, that is, far too much, food. My husband and I are big eaters, but most of the time we can't come close to finishing a full meal at a restaurant.
Americans expect to get "value" for their money: the larger the portion, the greater the value. That's why restaurants are serving such large meals to an increasingly obese public that is always eager for more. This trend is unfortunate; eating larger quantities of nutritionally deficient food is not the way to go. In other countries, especially in Europe, value in a meal comes from the taste and quality of the meal, not from the quantity of food piled on a plate.
One of the best means of restaurant portion control that I know of, and one that my family and I practice, is simply to ask the waiter to split the meal in two. The cook usually will do this for a minimal charge, and you get just as many vegetables but only half the (huge) portion of the meat, fish, or main part of the entrée. That way, we don't overeat, and we have spent less too, getting real "value" for our money. Other people I know simply ask for doggie bags instead of eating everything on their plates.
Of course, it's not just restaurants that offer such "value." I'm sure the first mountain of mashed potatoes many of us ever saw was not dished up by the local Hi-Cal Diner: It was served at home. Start early with your kids. At home, you can serve large portions of fresh vegetables and fruits and adequate and satisfying portions of protein-rich foods and starches. That way, you'll help shape their concept of the type and amount of food they need in order to feel full. It's the first step on the road to healthy eating and long-term weight control.
EATING WELL AND LOVING IT
A good meal-as opposed to a huge meal-is one of life's greatest pleasures. It does far more than appease hunger and provide the benefits of nutrition. For me, much of the pleasure in eating comes from sharing the time with my family, or if I am away, with colleagues and friends.
The lost art of pleasurable eating
We are so fortunate to live in a time of plenty and in an era of scientific discovery. And though we should be enjoying the benefits of recent studies that show the strong link between good health and good nutrition, many of us have lost touch with real, wholesome food and the pleasures of mealtime.
We all know the reasons why: work schedules that extend into the evening hours (both in one- and two-parent households); children's after-school activities, many of which involve parents as well; television, which hinders almost any continuous conversation; the seductions of computer games and the Web. With all this competition, there's scarcely any time left for meals that are enjoyed for themselves, whether eaten alone or shared with others. I think this is one of the worst changes in the way we live, and it has had a harmful effect on our nutrition and health.
At home, I look forward to evening meals, when my family sits down around the dinner table, sometimes with neighbors and visiting friends, and we catch up on the events of our day and share good conversation and delicious food. It's true that this rosy picture is not realized every night. There are times when my husband or I are away from home and times when one or all of the children are eating elsewhere. But the habit, or ritual if you like, of sitting down together without the television on has been established. That time together makes a difference to all of us.
Fads, food obsessions, and extreme eating
From aphrodisiacs to cold remedies, there have always been fads and obsessions about food. Some are based on actual science, usually one small piece of information isolated from a larger body of science; some are based on quasi-science-the blanket condemnation of fat is a good example-and some are simply bubbameisses, tales your grandmother told you.
Three areas of nutrition currently preoccupy many Americans: fats (all bad), proteins (eat all you can for rapid weight loss), and carbohydrates (they're fattening; avoid them). These are extreme positions, and they are held by those who have the most to gain: the biased scientists who sell the fad diets, and the food industry that creates, promotes, and sells the processed foods that support the diets. The facts, as opposed to the fads, are that each of these foods is essential to our health if eaten in the amounts that are recommended.
Such phobias and obsessions not only harm our health, they prevent us from enjoying food. I can't tell you how often I've been out for a meal with the kind of person who is so ruled by fear of fat or carbohydrates that she is almost paralyzed by the act of ordering food-so what she has is just a salad with dressing on the side. Her usual lunch is a bag of fat-free pretzels, a container of fat-free yogurt (sometimes it's sugar-free, too-I can't imagine what's in it), and a diet soda, which she eats at her desk. Where is the pleasure? Where is the nutritional boost she needs to sustain her for the rest of the afternoon?
One of the themes of this book is that we need to be aware of what we eat. Awareness is not vigilance, and the fear of food can be as unhealthy and as reckless as indifference to it.
I am very fortunate that my work has given me the opportunity to meet and speak with women all over America, and in other countries as well. Most women tell me they know that good nutrition is the key to good health, but they are not always sure what their nutritional goals should be and how to achieve them.
I believe that taking care of your body is part of your human job description, and the best way to start is by eating well. I wrote Strong Women Eat Well to help you create your own healthy and pleasurable way to eat, one that will optimize your nutritional status and, at the same time, reflect your food preferences and your lifestyle. For me, good nutrition and pleasure are concepts that embrace the entire world of food. I strongly believe that the more variety of fresh whole foods you eat, coupled with regular exercise, the healthier you will be.
Here's to your health!