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  THE HARVARD HEALTHY EATING PLATE

  Figure 1. The Harvard Healthy Eating Plate was created to address deficiencies in the USDA’s MyPlate. It provides simple but detailed guidance to help people make the best eating choices.

  • Go for whole grains—about one-quarter of your plate. Intact and whole grains, such as whole wheat, barley, wheat berries, quinoa, oats, brown rice, and foods made with them, have a milder effect on blood sugar and insulin than white bread, white rice, and other refined grains (see chapter six).

  • Choose healthy protein packages—about one-quarter of your plate. Fish, chicken, beans, soybeans, and nuts are all healthy, versatile protein sources. Limit red meat, and try to stay away from processed meats such as bacon and sausage (see chapter seven).

  • Use healthy plant oils, such as olive, canola, soy, corn, sunflower, and peanut, in moderation. Stay away from foods containing partially hydrogenated oils, which contain unhealthy artificial trans fats (see “Trans fats,” page 83). If you like the taste of butter or coconut oil, use them when their flavor is important but not as primary dietary fats. Keep in mind that low-fat does not mean healthy (see chapter five).

  • Drink water, coffee, or tea. Skip sugary drinks. If you enjoy milk, don’t have more than two glasses a day (see chapter nine). If you drink alcohol, keep it moderate—no more than two drinks a day for men, no more than one a day for women.

  • Exercise. It’s good for overall health and controlling weight.

  Using the blueprint laid out in the Harvard Healthy Eating Plate is a good way to improve your diet. But I also want you to see the evidence on which it was built. This is detailed in chapters four through eleven. In them, I describe the classic and cutting-edge research that has defined and refined eating patterns that will help keep you healthy, including new information on slowly digested carbohydrates; what kinds of fruits and vegetables are particularly important to include in your diet; what protein can and can’t do; how to put the omega-3 fats found in fish and some plants to work for you; the potential hazards of consuming too much milk and other dairy foods; and why it makes sense to take a daily multivitamin.

  This book helps you incorporate this information into your snacks and meals with practical tips on buying healthy foods and eating defensively in a food environment that entices you to eat in ways that can prematurely end your life. It offers extra information to help individuals with special nutritional needs get the most benefit from what they eat. These include pregnant women, frail older individuals, those with celiac disease, and those with or at high risk of heart disease, diabetes, high cholesterol, high blood pressure, or some other chronic conditions. It ends with more than seventy tasty tested recipes.

  This information isn’t meant to replace the advice you get from your physician, especially if you have a condition that requires a specific diet. Instead, I encourage you to talk with your health care provider about your diet and share with him or her what you’ve learned from this book to make sure you are talking the same language about healthy eating. Keep in mind that most physicians-to-be get little education about nutrition in medical school or beyond. And the pressures of modern medicine and health care often make it difficult for clinicians to keep up with the field of nutrition, let alone spend time talking with their patients about healthy food choices. You may find yourself teaching your health care provider.

  Not long ago my cholesterol began creeping up. Much to my dismay, my doctor recommended that I start a low-fat diet—a recommendation from the 1980s that we now know doesn’t work for lowering cholesterol.

  This book will help you stay healthy and educate your doctor if you need to.

  CHAPTER TWO

  * * *

  Of Pyramids, Plates, and Dietary Guidelines

  THROUGHOUT MOST OF HUMAN HISTORY, the relatively brief life span of our species (during the Roman Empire, the average life expectancy at birth was under thirty years) meant that it didn’t much matter what you ate as long as you took in enough calories to survive. Most Romans didn’t live long enough for diet-related conditions like heart disease, type 2 diabetes, and cancer to take root.

  That’s changed. Today the average American lives for nearly eighty years, so what you eat matters as much as how much you eat.

  We aren’t born knowing how to choose healthy foods. Most of us need some help, especially in this era when food, food ads, and dietary advice are everywhere. Consider this book as your personal guide for navigating the sea of information, misinformation, and disinformation that surrounds all of us.

  AN ABUNDANCE OF ADVICE

  Actually, advice on healthy eating has never been in short supply. More than two thousand years ago, Greek physician and philosopher Hippocrates made diet (and exercise) the centerpiece of good health and the basis for treating disease. Here’s just one of his recommendations that sounds familiar today: Suitable vegetables, cooked or raw, must be eaten in abundance.

  Fast-forward fifteen hundred years and the human life span was increasing. Soon after the invention of the printing press in the mid-1400s, Bartolomeo Platina’s De honesta voluptate et valetudine (On Honorable Pleasure and Health) became a bestseller throughout Europe. Aiming to combine health with the pleasure of eating, it melded medical advice with recipes taken from other published works.1 In the 1860s a low-carb diet devised by London undertaker William Banting2 became so wildly successful that the term “Banting” was used for years in Europe and the United States as a synonym for “dieting.”

  Today, hundreds of diet books are published each year, along with innumerable diet-related websites, Facebook pages, and blogs. Much of the advice they offer is misleading or erroneous.

  You’d think you could turn to the federal government for accurate, safe recommendations about healthy eating. You’d be wrong.

  “OFFICIAL” ADVICE

  The United States government got into the dietary recommendation business in 1894. That’s when the U.S. Department of Agriculture (USDA) published Foods: Nutritive Value and Cost by W. O. Atwater.3 The department continued to churn out a steady stream of recommendations throughout the 1900s.

  In the 1960s and 1970s, two different trends in the United States sparked renewed interest in diet and nutrition. One was the growing concern about hunger and malnutrition, highlighted in part by the 1968 television broadcast of Hunger in America, a powerful CBS News special report. The other was the growing number of Americans who were developing and dying from cardiovascular disease.

  In response, Senator George McGovern of South Dakota created the United States Senate Select Committee on Nutrition and Human Needs. In 1977 the committee issued a report called Dietary Goals for the United States (also known as the McGovern Report) that urged Americans to eat less fat, less cholesterol, less refined and processed sugars, and more complex carbohydrates and fiber. That set the stage for the first official Dietary Guidelines for Americans in 1980. According to the USDA, this document provided “authoritative advice for people two years and older about how good dietary habits can promote health and reduce risk for major chronic diseases.”4 The law authorizing the Dietary Guidelines for Americans fortunately understood that science is an ongoing process and that evidence changes, and so mandated that the guidelines must be revised every five years.

  Each five-year update starts with the appointment of a scientific advisory committee made up of diet and nutrition experts from around the country. They are charged with reviewing the available data on diet. In theory this review should provide an unbiased summary of the scientific evidence. But the beef and dairy industries have worked hard to ensure that some committee members represent their interests.

  After the committee issues its report, the USDA and the U.S. Department of Health and Human Services work behind closed doors to “translate” this review into the official guidelines. This leaves open numerous back channels through which economic and political influences can twist and recast the scientific evidence. In the 2015–2020 updat
e, for example, the advisory committee recommended limiting the consumption of red meat. But the guidelines presented to the American public didn’t say that and instead recommended consuming lean meat.

  What should be a scholarly and scientific process is often a free-for-all among lobbyists for agribusinesses, food companies, and special interest groups.

  The Dietary Guidelines for Americans are supposed to help us choose foods that will keep us healthy and stay away from those that don’t. Unfortunately, their advice has often been murky or downright misleading. The 2010 guidelines, for example, told Americans to avoid “solid fats” but didn’t come out and say that the way to do this was by eating less red meat and dairy foods.

  The failings of the guidelines are a shame, because millions of people look to them as a model for healthy eating. Their reach goes even further than helping individuals choose healthy diets: they also form the basis for federal food policies such as the Special Supplemental Nutrition Program for Women, Infants, and Children, school lunches, and food served in government facilities, such as military bases and prisons.

  UNDUE INFLUENCE

  One of the big problems with the Dietary Guidelines for Americans and the highly popular and influential icons derived from them (more about that later) is that they come from the USDA—the agency responsible for promoting American agriculture—with some input from the Department of Health and Human Services. What’s good for American farmers isn’t necessarily good for Americans’ health. Just look at their reluctance to say “Eat less red meat,” which would be terrific for health but bad for ranchers and the influential beef industry. (This oversight of competing interests isn’t unique to the USDA. The Nuclear Regulatory Commission, for example, is charged with the often contradictory tasks of promoting nuclear power and regulating its use.)

  The influence of the USDA—not to mention that of powerful lobbies operating through Congress as well as directly targeting the USDA—has shaped federal recommendations on what we should eat as much as, if not more than, science has.

  In Rudyard Kipling’s classic children’s story “The Elephant’s Child,” elephants didn’t originally have trunks, only bulging blackish noses as big as a boot. That changed when the curious elephant’s child ended up in the middle of a terrific tug-of-war with a crocodile clamped onto its nose and a python wrapped around its legs.

  Fast Fact: How the U.S. Constitution Affects Diet

  * * *

  I once had lunch in Rome with George McGovern, then the U.S. representative to the World Food Programme, whose work in the U.S. Senate paved the way for the Dietary Guidelines for Americans. He pointed out to me that the U.S. Constitution, by giving every state two senators, is a powerful influence on agriculture policy. The sparsely populated Western states, with large ranching and other agricultural interests, play a disproportional role in Congress, which controls the USDA budget and leadership appointments. It’s no wonder that the Dietary Guidelines for Americans, which is inexplicably under the USDA’s leadership, don’t promote plant-based diets.

  A tug-of-war is pretty much how the Dietary Guidelines for Americans and their representative icons get their shapes—yanked this way and that by competing powerful interests, few of which have your health as a central goal. These include the National Dairy Council, the Soft Drink Association, the American Beverage Association, the North American Meat Institute, the National Cattlemen’s Beef Association, the Salt Institute, the Wheat Foods Council, and others. The end result of this tug-of-war between the food industry and nutrition science is generally a set of positive, feel-good, all-inclusive recommendations that distort what should be an important tool for improving your health and the health of the nation—guidelines on healthful eating.

  THE PYRAMID ARISES

  IN 1992 THE USDA UNVEILED the influential Food Guide Pyramid. The goal was to make the Dietary Guidelines more accessible. It was built with the help of public relations giant Porter Novelli, whose current and former clients include McDonald’s, the Snack Food Association, Krispy Kreme, Johnnie Walker, and Masterfoods USA, maker of M&M’s. The Food Guide Pyramid was supposed to simply and visually convey the elements of the Dietary Guidelines for Americans, which were inherently flawed. The pyramid highlighted those flaws. It recommended:

  THE USDA’S ORIGINAL FOOD GUIDE PYRAMID

  Figure 2. USDA Pyramid, 1992–2005. Despite sweeping changes in the science of healthy eating, this initially flawed pyramid went unchanged for thirteen years.

  • eating lots of carbohydrates, most of which were unhealthy, highly processed carbohydrates such as white bread and white rice

  • eating some fruits and vegetables, including potatoes (which are mostly a starchy carbohydrate)

  • choosing meat, milk, and cheese as sources of protein

  • not eating any types of oils or fats (including healthy ones).

  Using a pyramid to convey dietary advice was a stroke of marketing genius. It placed “good” foods, which should be consumed in larger quantities, on the bottom; “bad” ones, which should be consumed in smaller quantities, on the top; and everything else in between. A pyramid also sends the subliminal message that the advice is rock solid and long-lasting and rises above the jungle of misinformation and contradictory claims. But what the Food Guide Pyramid really offered was wishy-washy, scientifically unfounded advice on an absolutely vital topic—what to eat.

  Some recommendations on diet and nutrition are misguided because they are based on inadequate or incomplete information. That wasn’t the case for the USDA’s pyramid. Its recommendations were wrong because they ignored solid evidence on healthful eating and aimed to please various food lobbies.

  The Food Guide Pyramid’s most health-damaging faults were:

  • All fats are bad. Wrong: some fats are good for you and are even essential for life (see chapter five). The Food Guide Pyramid’s recommendation to use fats “sparingly” helped foster the phobia about fat that led many Americans to throw out the baby with the bathwater.

  • All “complex” carbohydrates are good. The Food Guide Pyramid ignored the fact that some kinds of carbohydrates are significantly less healthy than others (see chapter six). Eating too much of the wrong kinds of carbs and too little of the right kinds can set you up for weight gain, type 2 diabetes, and heart disease.

  • All protein sources are equally good. True: protein from steak and salmon is quite similar. But the protein package is vastly different (see chapter seven). Some high-protein foods deliver a lot of things that aren’t so healthful, like saturated fat, cholesterol, and salt. Others provide healthy fats and additional good-for-you nutrients like fiber, vitamins and minerals, and a host of beneficial phytochemicals (literally, chemicals made by plants).

  • Dairy foods are essential. Not true: you need calcium, not milk. Dairy foods are good sources of this mineral but also deliver plenty of calories and saturated fat. If you need extra calcium, there are cheaper, easier, and healthier ways to get it than dairy foods (see chapter eleven).

  • Silence on weight, exercise, alcohol, and vitamins. Like the Sphinx, the Food Guide Pyramid was silent on four things you need to know about: the importance of weight control, the necessity of daily exercise, the potential health benefits of a daily alcoholic drink, and what you can gain by taking a daily multivitamin.

  AN INJECTION OF SCIENCE AND THE CRUMBLING OF THE PYRAMID

  As soon as the Food Guide Pyramid was unveiled, research from around the globe began to erode it at all levels. Results from scores of large and small studies chipped away at its foundation (carbohydrates), middle (meat and milk), and top (fats).

  Back in the late 1970s, several colleagues and I realized that there was little solid evidence available on which to base recommendations for healthy eating. We saw an opportunity to change this through the Nurses’ Health Study (see “Praise for Nurses and Health Professionals,” page 33) which had been started in 1976 to investigate the long-term consequences of oral con
traceptives. A few years later we created a similar long-term study of male health professionals. Thanks to both of these long-term cohort studies, we have been able to follow the eating patterns, lifestyle habits, and health of thousands of women and men for several decades (for more details, see chapter three). The treasure trove of data from this work has let us discover the benefits and harms of different eating patterns and find links between various foods and cancer, diabetes, cardiovascular disease, osteoporosis, and other chronic conditions. What emerged fairly early from this work, and from studies by others around the world, was that the picture of a healthy diet was quite different from that portrayed by the USDA pyramid.

  We decided to test whether people who followed the Dietary Guidelines for Americans and its Food Guide Pyramid actually experienced better health and greater life expectancy than those who didn’t. To do this, my colleagues and I used the Healthy Eating Index.5 This scale was devised by the USDA’s Center for Nutrition Policy and Promotion “to measure how well American diets conform to recommended healthy eating patterns.” The index assigns scores of 0 to 10 for each of ten dietary components that were the focus of the original Food Guide Pyramid and the 1995 Dietary Guidelines for Americans: the number of daily servings of grains, vegetables (including potatoes), fruits, meat, and dairy products; lower intakes of total fat, saturated fat, dietary cholesterol, and sodium; and variety of the diet. A score of 100 meant perfectly following the USDA’s recommendations, while a score of 0 meant totally disregarding them.

  We extracted information on eating patterns from questionnaires that more than 135,000 female nurses and male health professionals had been completing every four years for more than a decade. Using this information, we calculated a Healthy Eating Index score for each individual. Those with the highest scores—meaning they closely followed the USDA’s advice—were just as likely to have developed a major illness or to have died over a twelve-year period as those with the lowest scores. Heart attacks were only slightly less common among those with high Healthy Eating Index scores than they were among those with low scores.6