Eat, Drink, and Be Healthy Read online

  Medical and nutrition experts weigh in on the groundbreaking eating plan based on Harvard Medical School research

  Eat, Drink, and Be Healthy

  by Walter C. Willett, MD, DrPH

  “Dr. Willett describes a way to eat that is both delicious and healthy. Many nutritional scientists will strongly dispute Dr. Willett’s contention that our national symbol of healthy eating, the USDA Food Pyramid, is unhealthy. However, very few will deny that the prescription in this book is a good one.”

  —Susan Roberts, Ph.D., senior scientist, Energy Metabolism Laboratory, USDA Human Nutrition Research Center at Tufts University

  “Finally we can step away from the hype and confusion of fad diets and turn instead to a solidly researched guide we know we can trust. I am grateful to Dr. Willett and his associates for making this information so clear and accessible. Throw away your other volumes; this is all you will need.”

  —Mollie Katzen, author of The Moosewood Cookbook

  “Willett has studied real women (not rats) over many years in the Nurses’ Health Study and distilled it into a readable guide for healthy living. This is the book on nutrition every woman should read.”

  —Susan Love, M.D., author of Dr. Susan Love’s Breast Book and Dr. Susan Love’s Hormone Book

  “Eat, Drink, and Be Healthy is a welcome beacon of clarity among the fog of misleading claims that make up the vast majority of diet books on the market. Dr. Willett’s recommendations for healthy eating are based on a sound interpretation of current scientific knowledge, flavored by a joyful appreciation of traditional foodways. Unlike most diet books, he does not emphasize manipulation of one isolated physiological mechanism as a ‘cure-all.’ Rather, he applies a commonsense interpretation of wide-ranging scientific studies on diet and health. In the process, he challenges widely accepted but poorly supported ideas about nutrition and health, whether they come from the popular press or from federal government committees. The ultimate winners are the readers of this book, who will come away with the tools, guidance, and rationale they need to explore new ways of eating that are delicious, health-promoting, and based on the best of science and tradition.”

  —Lawrence H. Kushi, Sc.D., Associate Director for Etiology and Prevention, Kaiser Permanente

  CRITICS NATIONWIDE APPLAUD THIS PIONEERING GUIDE

  “This excellent and controversial book offers a modified food pyramid that’s heavy on fruits, vegetables, and monosaturated oils and nuts. . . . [Dr. Willett] is a heavy hitter in the world of nutrition, so expect his book to exert influence beyond your bookshelf.”

  —Detroit Free Press

  “[A] standout health book. . . . Particularly insightful is Willett’s revised version of the U.S. Food Guide Pyramid.”

  —Chicago Tribune

  “Eat, Drink, and Be Healthy wins with easy-to-digest research information and lots of tempting recipes.”

  —Copley News Service

  “Toss out your old diet books, forget the government’s famous but flawed food pyramid, and get your hands on Eat, Drink, and Be Healthy, by Walter Willett.”

  —The Boston Globe

  “[Willett’s] new theory threatens to upend the government’s food pyramid, [which he says] is outdated and doesn’t reflect the latest food research. . . . Willett’s criticism may prompt many people to view it more skeptically because of his clout in the nutrition field.”

  —USA Today

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  Contents

  Acknowledgments

  CHAPTER ONE Healthy Eating Matters

  CHAPTER TWO Of Pyramids, Plates, and Dietary Guidelines

  CHAPTER THREE What Can You Believe About Diet?

  CHAPTER FOUR Healthy Weight

  CHAPTER FIVE Straight Talk About Fat

  CHAPTER SIX Carbohydrates for Better and Worse

  CHAPTER SEVEN Choose Healthier Sources of Protein

  CHAPTER EIGHT Eat Plenty of Fruits and Vegetables

  CHAPTER NINE You Are What You Drink

  CHAPTER TEN Calcium: No Emergency

  CHAPTER ELEVEN Take a Multivitamin for Insurance

  CHAPTER TWELVE The Planet’s Health Matters Too

  CHAPTER THIRTEEN Putting It All Together

  CHAPTER FOURTEEN Healthy Eating in Special Situations

  CHAPTER FIFTEEN Shopping Tips, Recipes, and Menus

  RECIPES

  Appetizers and Beverages

  Avocado-Shrimp Salsa (FAST FIX)

  Sun-Dried Tomato Dip with Oven-Roasted Corn Chips (FAST FIX)

  Fruit ’n’ Spicy Nut Trail Mix (FAST FIX)

  Blackberry-Banana Smoothie (FAST FIX)

  Strawberry-Almond Shake (FAST FIX)

  Mango Energy Blitz (FAST FIX)

  Breads and Grains

  Carrot–Wheat Germ Muffins

  Carrot-Apple-Ginger-Nut Muffins

  Banana-Apricot Nut Bread

  Hearty Wheat Berry–Oat Groat Bread

  Multigrain Hotcakes with Warm Apple Syrup

  Griddle-Baked Semolina Pancakes with Sweet Date-Orange Filling

  Menemen (Turkish–Style Scrambled Eggs) with Pita Bread

  Entrées

  Chicken Enchilada Casserole

  California Chicken Salad (FAST FIX)

  Moroccan Chicken Tagine

  Chicken and Vegetable Stir-Fry

  Thai Basil Chicken with Long Beans

  Tandoori Tuna (FAST FIX)

  Lemon-Oregano Grouper with Vegetables

  Pad Thai–Style Fried Rice

  Grilled Salmon Steaks with Papaya-Mint Salsa

  Spicy Shrimp and Peanut Noodle Salad

  Double Mushroom Meat Loaf

  Vegetarian Entrées

  Spicy Tofu Salad

  Cold Soba Noodles with Orange-Ginger Glaze

  Watercress Salad with Currants and Walnuts

  Tempeh Salad with Pita and Pine Nuts

  Onion-Crusted Tofu-Steak Sandwich

  Farro and Mushroom Burgers

  Asparagus, Tofu, Shiitake, and Cashew Stir-Fry (FAST FIX)

  Portobello and Caramelized Onion Pizza

  Roasted Walnut and Brown Rice Loaf

  Lentil Nut Loaf with Red Pepper Sauce

  Winter Squash with Pecan Stuffing

  Butternut Squash, Apple, and Cranberry Gratin

  Farro and Roasted Butternut Squash

  Soups and Stews

  Wheat Berry and Lentil Soup

  Tomato Soup

  White Bean, Chicken, and Spinach Soup

  Tunisian Chickpea Breakfast Stew

  Oldways Sweet Potato Peanut Stew (Mafe)

  Chipotle Chicken Chili

  Simple Seafood Stew

  Chinese Cioppino with Scallops and Shrimp

  Sides

  Pear and Mixed Green Salad

  Greek Salad

  Roasted Winter Vegetable Medley

  Dijon-Herb Carrots

  Spicy Sweet Potato Fries

  Cardamom Roasted Cauliflower

  Wilted Spinach with Nuts and Golden Raisins (FAST FIX)

  Lemony Kale with Toasted Almonds (FAST FIX)

  Oldways Tangy Collard Greens

  Bitter Greens with Sweet Onions and Tart Cherries


  Brazilian Greens

  Tuscan Beans

  Wild Rice–Quinoa Pilaf

  Roasted Corn Tabbouleh

  Wild Mushroom–Barley Risotto

  Pistachio-Apricot Bulgur Salad (FAST FIX)

  Desserts

  Apple-Cherry Crumb Pie

  Orange Juice Sorbet

  Spiced Poached Pears

  Slow-Roasted Spiced Peaches

  The Three Pleasures

  Mango Granita with Chocolate-Coated Macadamia Nuts

  Chocolate Cherry Walnut Truffles

  Oatmeal-Raisin and Nut Cookies

  Sweet Spiced Couscous

  About the Author

  Further Reading

  Index

  Credits

  To Gail

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  Acknowledgments

  THE CONCEPTS IN THIS BOOK owe much to the work and ideas of many predecessors, present colleagues, postdoctoral fellows, and doctoral students. In particular, I am grateful for the encouragement, support, and thoughts of my colleagues Ed Giovannucci, Meir Stampfer, Graham Colditz, Bernard Rosner, Laura Sampson, JoAnn Manson, Frank Sacks, David Hunter, Charles Hennekens, Sue Hankinson, Eric Rimm, Frank Hu, and Alberto Aschiero of the Channing Laboratory and Harvard School of Public Health. Frank Speizer provided strong support over many years for the study of diet and disease within the Nurses’ Health Study.

  The vast majority of the research described in this book, by our own group and by others, would not have been possible without the funding of research grants through the National Institutes of Health. My colleagues and I are most appreciative of the strong public support for health-related research in the United States, and hopefully the information contained in this book will be deemed worthy of this investment.

  Many helpful comments were received from Drs. Meir Stampfer, Susan Roberts, Frank Sacks, Eric Rimm, Peter Glausser, and Mollie Katzen, who reviewed all or specific chapters of this book. Dr. Tony Komaroff and Edward Coburn of Harvard Medical School provided important support and encouragement in the initial development of this book, and Liz Lenart and Debbie Flynn assisted in many aspects of the production. I also want to thank Simon & Schuster and Bill Rosen in particular for their vision of creating a series of high-quality books about health from Harvard Medical School.

  At home, my wife, Gail, assisted in many experiments in new ways of eating. Our sons Amani, who managed to trade the apples in his lunch for Twinkies at day care, and Kamali, who showed me that a vegetarian diet could mean Coca-Cola, ice cream, and pizza, helped me stay in touch with reality.

  CHAPTER ONE

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  Healthy Eating Matters

  YOU EAT TO LIVE.

  It’s a simple, obvious truth. You need food for the basics of everyday life—to pump blood, move muscles, think thoughts. But what you eat and drink can also help you live well and live longer. By making the right choices, you can avoid some of the things we think of as inevitable penalties of getting older. Eating well—teamed with keeping your weight in the healthy range, exercising regularly, and not smoking—can prevent 80 percent of heart attacks, 90 percent of type 2 diabetes, and 70 percent of colorectal cancer.1 It can also help you avoid stroke, osteoporosis, constipation and other digestive woes, cataracts, and aging-related memory loss or dementia. And the benefits aren’t just for the future. A healthy diet can give you more energy and help you feel good today. Making poor dietary choices—eating too much of the wrong kinds of food and too little of the right kinds, or too much food altogether—can send you in the other direction, increasing your chances of developing one or more chronic conditions or dying early. An unhealthy diet during pregnancy can cause some birth defects and may even influence a baby’s health into adulthood and old age.

  When it comes to diet, knowing what’s good and what’s bad isn’t always easy. The food industry spends billions of dollars a year to influence your choices, mostly in the wrong direction. Diet gurus promote the latest fads, most of which are less than healthy, while the media serves up near daily helpings of flip-flopping nutrition news. Supermarkets and fast-food restaurants also offer conflicting advice, as do cereal boxes and thousands of websites, blogs, Facebook pages, and tweets. The federal government, through its Food Guide Pyramid, MyPyramid, and MyPlate images, aimed to cut through the confusion but ended up giving misleading and often unhealthy recommendations (see chapter two) that benefit American agriculture and food companies more than Americans’ health.

  While the average American diet still has a long way to go before it can be called healthy, it has improved over the past decade or so in spite of the babel of nutrition information. Several of my colleagues and I looked at the diets of almost 34,000 Americans who took part in the National Health and Nutrition Examination Survey between 1999 and 2012. This survey, conducted every year, gauges the diet, health, and nutritional status of a sample of adults and children in the United States. We rated the diet of each participant using a tool we developed that assigns higher points to healthy components of the diet, like eating whole grains and unsaturated fats, and lower points to unhealthy components, like eating red meat and drinking sugar-sweetened beverages. The highest score, 110, indicates the healthiest diet possible. We were delighted to report that the quality of the American diet improved between 1999 and 2012.2 Consumption of artery-damaging trans fats declined by 80 or 90 percent, and Americans drank about 25 percent fewer sugar-sweetened beverages. On average, people ate slightly more fruit, whole grains, and healthy unsaturated fats. Our study showed that the average American diet still wasn’t very healthy—rating 48 points out of 110—and that poorer individuals and those with less education have poorer diets than wealthier and better-educated individuals. And this gap looks like it is increasing over time.

  Yet, these modest improvements in diet quality had an astounding impact on the health of the nation. Between 1999 and 2012, we estimated that these changes prevented 1.1 million premature deaths from heart attacks, strokes, cancer, and other causes, and 3 million cases of type 2 diabetes. But there’s more work to be done, since the “average American diet” in this study wasn’t that great. The eating strategies described in this book will help you make a great diet and reap not only the benefits described in this study but many more as well.

  SIMPLE STEPS

  I wrote Eat, Drink, and Be Healthy in 2001 to cut through the confusion about diet. Basing the book on the most reliable scientific evidence available then, I offered recommendations for eating and drinking healthfully. Sixteen years and thousands of scientific papers later, the recommendations in this edition of the book are fundamentally the same, though supported with more extensive evidence and enhanced with important new details. That’s encouraging, because it means that, with careful attention to the types and strength of studies, we can make conclusions about healthy eating that withstand the test of time and deep scientific scrutiny. However, the book needed to be updated, because far too many Americans are still confused about what constitutes a healthy diet and are looking for the best available information.

  Even more encouraging is that national recommendations on healthy eating, called the Dietary Guidelines for Americans,3 have been inching closer to what I advised in 2001 and still advise today.

  I can’t quite rival the brevity of food writer Michael Pollan’s seven-word dietary credo, “Eat food. Not too much. Mostly plants.”4 That’s a decent general overview, but it doesn’t offer much real guidance. That’s exactly what this book provides.

  Here is the outline of my simple, actionable advice for healthy eating, which I describe in detail later in the book:

  • Eat plenty of vegetables and fruits, but limit fruit juices and corn, and hold the potatoes.

  • Eat more good fats (these mostly come from plants) and fewer bad fats (these mostly come from meat and dairy foods).

  • Eat more whole-grain carbohydrates and fewer refined-grain carbohydrates.

  • Choose healthy sources of p
rotein, limit your consumption of red meat, and don’t eat processed meat.

  • Drink more water. Coffee and tea are okay; sugar-sweetened soda and other beverages aren’t.

  • Drink alcohol in moderation, if at all.

  • Take a multivitamin for insurance, just in case you aren’t getting the vitamins and minerals you need from the foods you eat. Make sure it delivers at least 1,000 international units of vitamin D.

  Since the last edition of the book, many studies have supported the benefits of a primarily plant-based diet. This doesn’t mean you must go vegan or vegetarian. Even a partial shift away from a meat- and dairy-centered diet and toward more plant sources of protein is a big step in the direction of long-term good health for you and planet Earth (see chapter twelve). If swearing off meat isn’t for you, think about trying the “vegan till 6” plan favored by New York Times food writer Mark Bittman. Or experiment with the popular Meatless Monday movement and one day a week—choosing Monday makes it easy to remember, but it could be any day—not eat any meat.

  While many food experts (Pollan, Bittman, and myself among them) agree with a plant-based diet, the USDA hasn’t been entirely on board with it. You can see that in MyPlate, a less-than-healthy infographic the USDA cooked up to summarize the dietary recommendations in the 2010 Dietary Guidelines for Americans (see chapter two).

  To counter that flawed information, I and several of my colleagues at the Harvard T.H. Chan School of Public Health, in collaboration with Harvard Health Publications, distilled the best evidence about healthy eating into the Harvard Healthy Eating Plate. This visual, evidence-based guide makes it easy to choose the healthiest options. It’s also an important alternative to the USDA’s misleading My Plate (see chapter two).

  The main message of the Healthy Eating Plate, like its older sibling, the Healthy Eating Pyramid, is to focus on diet quality.

  • Celebrate vegetables and fruits: Cover half of your plate with them. Aim for color and variety. Keep in mind that potatoes don’t count (see “The Spud Is a Dud” on page 167).