BOOK REVIEW

Eat, Drink, and Be Healthy
by
Walter C. Willett

FUTURECASTS online magazine
www.futurecasts.com
Vol. 4, No. 11, 11/1/02.

Homepage

Authoritative myths from the USDA:

 

The USDA misinformation contributes to overweight, poor health, and unnecessary early deaths.

  This Harvard Medical School Guide to Healthy Eating - "Eat, Drink, and Be Healthy" by Walter C. Willett, - co-developed with The Harvard School of Public Health - reassuringly starts with a blast at the U.S. Department of Agriculture's "Food Guide Pyramid."

  "At best, the USDA Pyramid offers wishy-washy, scientifically unfounded advice on an absolutely vital topic - what to eat. At worst, the misinformation contributes to overweight, poor health, and unnecessary early deaths. In either case, it stands as a missed opportunity to improve the health of millions of people."

In the tug of war between public health and agricultural interests, the USDA naturally favored the agricultural interests.

  "Competing powerful interests, few of which had your health as a central goal," shaped the USDA Pyramid. In the tug of war between public health and agricultural interests, the USDA naturally favored the agricultural interests. Its Pyramid is actually designed to promote agricultural products.

  "The end result of their tug-of-war is a set of positive, feel-good, all-inclusive recommendations that completely distort what could be the single most important tool for improving your health and the health of the nation."

  Instead, Walter C. Willett offers a "Healthy Eating Pyramid." This is not a weight loss diet or a diet to overcome specific diseases. It is a guide - based on ordinary foods - that suggests changes that can "improve health and reduce the risk of chronic disease."

  "About the only thing that the Healthy Eating Pyramid and the USDA Food Guide Pyramid share is their emphasis on vegetables and fruits. Other than that, they are different on almost every level." 

  Willett candidly concedes that his Healthy Eating Pyramid may well change to reflect the scientific evidence constantly being developed. He also recommends the food guide pyramids developed by Oldways Preservation and Exchange Trust, the Asian Pyramid, the Latin Pyramid, the Mediterranean Pyramid, and the vegetarian pyramid. However, these don't take advantage of the latest research and are constrained by specific cultures so that they exclude many good foods now available from other cultures.

  Your government really doesn't give a damn about your well being. The USDA Food Guide Pyramid  is irrefutable proof of that. It is only outside pressure that on particular occasions pushes the government to concern itself with the well being of its citizens. Although there are many good people in the cognizant agencies who consistently do very good work when they are permitted to, when contrary interests are active and insufficiently opposed, it is those interests that guide government policy, rather than the broader public interest.
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  It is no different in other nations - as spectacularly proven from time to time by such actions as the initial rejection of foreign developed AIDS tests by France and Japan, and a variety of periodic health emergency cover ups.
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  Nor is the USDA unique among U.S. agencies. The author mentions the Nuclear Regulatory Commission - but there is little doubt that this type of response - placing political and bureaucratic interests ahead of the public interest - is the norm throughout government. Those who would increase dependence on the tender mercies of government for such things as health care and other goods and services need to dwell on this fact.

Willett's Healthy Eating Pyramid rests on solid scientific epidemiological research going back at least two decades.

  Daily exercise and weight control is emphasized by placing them at the broad base of the Healthy Eating Pyramid. The next three levels include basic foods. To be employed at most meals are whole grain foods - plant oils such as olive, canola, soy, corn, sunflower and peanut oils - and vegetables and fruits. Just above these come nuts & legumes (one to three times per day). Then, fish, poultry or eggs (up to twice a day).
 &
  At the smallest levels at the top of the pyramid are dairy or calcium supplements - which are limited to twice a day and generally discouraged - and red meat, butter, potatoes, sweets, and refined products such as refined rice, wheat and pasta - all to be used sparingly.
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  A multiple vitamin pill is also deemed advisable, and moderate consumption of alcoholic beverages is permitted.
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  Unlike the USDA Food Guide Pyramid and the vast array of contradictory "evidence free" diet books flooding the market, Willett asserts that his Healthy Eating Pyramid rests on solid scientific epidemiological research going back at least two decades.

  The medical profession has had to be dragged kicking and screaming into a recognition of the importance of food supplements and the dangers of red meat, dairy products, and refined grains. The much maligned - concededly not always unjustly much maligned - alternative health care practitioners - even many of the outright quacks - have been miles ahead of the medical profession for decades on these points.
 &
  It wasn't so long ago that doctors were disparaging food supplements as a waste. They claimed these supplements were almost all excreted, and reassured their patients with the highly dangerous assertion that even a diet of all junk foods was a sufficient source of nutrients because so much was consumed.
 &
  It is appropriate here to provide another reminder that - despite the availability of a very useful and increasing array of scientific tools and information - the delivery of health care is not a science in any meaningful sense. It is still a practical art based on clinical experience - and any doctor who restricts himself to just scientifically proven knowledge is per se incompetent.
 &
  Willett is indubitably correct. Scientific evidence is the most trustworthy - even where it is far from incontrovertible. But clinical experience is more than just "opinions and educated guesses." While certainly more prone to error than scientific evidence, clinical evidence is also evidence - often essential evidence - especially where science has not yet provided something better. Indeed, it is clinical evidence that frequently provides the first indications that some scientific evidence is suspect.

  Willett justly deplores "the pressures of modern medicine and health care [that] often make it difficult for clinicians to spend time talking about healthy food choices with their patients. (All clinical practice inevitably suffers when modern third-party-payer mass medicine restricts the time that doctors spend with patients.)

The USDA Food Guide Pyramid:

 

 

&

  Not only is the USDA Food Guide Pyramid devoid of scientific guidance, it now determinedly ignores the growing amount of scientific evidence flowing out of modern epidemiological studies and other scientific data.

  "In the ten years since the USDA Pyramid was designed and built, it has never been updated to reflect the wealth of new information that's become available on diet and health. Nor has it ever been tested to see if it really works. Until now."

The monounsaturated and polyunsaturated fats found in vegetable oils, nuts, whole grains, and fish "are good for your heart."

 

Refined (white) bread and rice and baked potatoes are turned into glucose (sugar) by the body and pumped into the bloodstream "almost as fast as it delivers the sugar in a cocktail of pure glucose."

 

Surges of blood sugar and the insulin responses they trigger are now implicated in the processes leading to heart disease and diabetes.

 

Red meat comes with too much saturated fat and cholesterol.

 

There doesn't seem to be any relationship between calcium intake and bone loss.

 

A baked potato has a greater impact on blood sugar and insulin spikes "than an equal amount of calories from pure table sugar."

  There have been absolutely no health benefits shown in modern broad based epidemiological studies from following the USDA eating guidelines, Willett points out.
 &
  Its "main and most health damaging faults:"

  • That all fats are bad and should be restricted to sparing use.

  There are two kinds of fats. The monounsaturated and polyunsaturated fats found in vegetable oils, nuts, whole grains, and fish "are good for your heart." It is the saturated fats and trans fats that are bad. (See, "Fats," below.)

  • That all "complex" carbohydrates are good - indeed, good enough to form the base of the USDA Food Guide Pyramid. 

  But baked potatoes, refined (white) bread and refined (white) rice are turned into glucose (sugar) by the body and pumped into the bloodstream "almost as fast as it delivers the sugar in a cocktail of pure glucose." These surges of blood sugar and the insulin responses they trigger are now implicated in the processes leading to heart disease and diabetes. The insulin surges ultimately cause rapid drops in blood sugar that induce feelings of hunger, and thus play a role in the overweight conditions that further increase the dangers of heart disease and diabetes.
 &
  Beans and whole grains like brown rice and oats and foods made from whole grains like whole wheat pasta and bread take longer to digest - provide steady flows of sugar and insulin response - extend the feelings of fullness - provide fiber and many vitamins and minerals - and thus protect against heart disease and diabetes. (See, "Carbohydrates," below.)

  • That all proteins are equivalent.

  But red meat comes with too much saturated fat and cholesterol. "Red meat may also give you too much iron in a form you absorb whether you need it or not." This may be harmful. (See, "Protein," below.)

  • Dairy products are advised as a means of fighting the "calcium deficiency emergency" of bone loss.

  But Americans get more calcium than residents of any nation except Holland and the Scandinavian nations. There doesn't seem to be any relationship between calcium intake and bone loss, and there are apparent relationships between high dairy consumption and increased risks of prostate and ovarian cancer.
 &
  Whole milk is loaded with saturated fats. Skimmed milk is a better choice, and inexpensive supplements and calcium-based antacids are available for those needing additional calcium. However, spinach, broccoli, tofu and calcium fortified foods are best and provide many other nutrients. (See, "Calcium," below.)

  • Potatoes are included among the favored vegetables.

  But  potatoes are a carbohydrate - mostly starch that is easily digested. This is alright for thin people who exercise regularly or do regular manual labor, but should be consumed in modest amounts - not as a daily vegetable - by everyone else. A baked potato has a greater impact on blood sugar and insulin spikes "than an equal amount of calories from pure table sugar." Traditional French fries do the same - with "an unhealthy wallop of trans fats" added.

  • Weight control, exercise, alcohol and vitamins are not mentioned by the USDA Pyramid.

The Healthy Eating Pyramid:

 

 

 

 

 

 

 

 

 

 

 

 

 

&

  Under Willett's Healthy Eating Pyramid:

  • Weight control - within reason - is the most important diet related health factor.

  • Then comes an emphasis on the healthy unsaturated fats and a restricting of the unhealthy saturated and trans fats from whole milk dairy products, butter and hydrogenated vegetable oils.

  • Then comes an emphasis on whole grain carbohydrates and avoidance of refined grain carbohydrates. Refined grain carbohydrates increase blood sugar and insulin surges, raise the levels of bad triglycerides and reduce the levels of good HDL cholesterol.

  • Then comes a shift to the healthier sources of protein - omitting red meat with its high levels of saturated fats and the potentially cancer causing compounds created when it is grilled or fried.

  • Fruits and vegetables - which doesn't include potatoes - are essential. These reduce risks of heart attacks, cancers, constipation and other digestive problems, as well as cataracts and macular degeneration. (See, "Fruits and vegetables," below.) 

  • Moderate alcoholic consumption - one drink per day for women, two for men - is advised mainly for older adults. This cuts the risk of heart attack and the risk of death from heart disease by one third, and also cuts the risk from clot-caused strokes. It may boost the good HDL cholesterol. However, like any drug, overuse leads to serious side effects. People prone to depression or alcoholism should of course avoid this drug. (See, "Fluids," below.)

  • Multivitamins are now conceded as useful - especially for folic acid, and vitamins B6 and B12 and D and E - to combat chronic diseases such as osteoporosis, cancer and heart disease. (See, "Vitamins," below.)

In diet epidemiological studies, controls are always uncertain, reports are always somewhat inaccurate, knowledge of the active ingredients in foods - and how much is actually absorbed - is still evolving, differences in dietary intakes of food elements are matters of degree rather than absolutes, and the diseases studied generally have complex causes including many factors not related to diet.

  Willett explains the often contradictory news about diet studies.

  "The problem is that newspapers, television, the Internet, and other news venues often turn the baby steps of scientific research into 'major cures' or highlight the confusing contradictions. This makes getting health news seem like reading pages torn at random from a book."

  Dietary advice prior to recent studies was based on slim evidence, and so was naturally less reliable and more subject to alteration or contradiction by more rigorous work. Willett asserts that - now that some rigorously obtained scientific evidence has been accumulated - there will be far fewer of these apparent alterations and contradictions in the future - although inevitably there will be some fine tuning - and sometimes more. This is the natural course of scientific inquiry.
 &
  Except for animal studies, this is predominantly not a laboratory science. In diet epidemiological studies, controls are always uncertain, reports are always somewhat inaccurate, knowledge of the active ingredients in foods - and how much is actually absorbed - is still evolving, differences in dietary intakes of food elements are matters of degree rather than absolutes, and the diseases studied generally have complex causes including many factors not related to diet.

  The difficulties and limitations of scientific epidemiological studies are properly acknowledged by Willett. But sometimes - especially when it is difficult or impossible to establish control groups or isolate individual factors from complex causes - not only are reliable studies difficult - they can become impossible.
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  The health benefits of whole garlic is a prime example - for obvious reasons. The health impacts of widely used chemicals that are ubiquitous in modern life is another. On such questions as these, clinical evidence is all there is - and those who reject the legitimacy of clinical evidence simply are left with no basis whatsoever for any professional opinions one way or the other. People in ever increasing numbers whose protective systems - due to aging or illness or genetics - leave them inordinately sensitive to food stresses or chemical stresses are thus driven to seek help from alternative health care providers - whose abilities vary widely, as might be expected.

Scientific findings:

  Willett reviews the various types of studies generally pursued, and provides some explanation of their strengths and weaknesses and many of their results.

  The limited number of health conditions studied constitutes another weakness. For all too many in the medical community, when examining suspect substances, if it doesn't cause cancer, cardiovascular ailments or birth defects, it's probable OK. It is greatly reassuring to see that these diet studies are much broader - adding such things as diabetes, weight conditions, digestive tract conditions, eyesight problems, bone loss and memory loss conditions. However, even adding these leaves much uncovered.
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  There are a host of other health problems. The immune system, detoxification systems, digestive system, hormonal systems and other body chemical balances are incredibly complex and frequently still poorly understood. Problems in these areas may not be lethal, but they can be debilitating enough to ruin a life.
 &
  Frequently, medical doctors have neither cures nor reliable treatments. It is not unusual for doctors to have bruised professional egos in these cases, and blame the patients or cruelly suggest that the patients - most already financially strapped - should waste their resources on inapt psychological help. In these areas, the better alternative health care practitioners applying clinical experience still frequently outperform medical doctors. But the world of alternative health care is a minefield where quacks prey on the desperate and ineffective and sometimes dangerous treatments lurk. Caveat emptor.

Weight:

   Next to smoking, weight is the most significant factor affecting health prospects. The author emphasizes the relationship between height and weight - the size of your waist - and how much you put on after your early twenties. He acknowledges the need for adjustments for body builders.
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In many undeveloped nations, obesity is already a greater health threat than malnutrition.

 

The upper boundary of the healthy range in the standard weight index is too high. The amount of weight gained after the early twenties - even if still in the healthy range - can have a major impact on health prospects. A waist that expands more than two or three inches over the years is a warning of health trouble.

  Being substantially overweight is clearly related to prospects for a Pandora's box of health evils. And obesity is a growing epidemic in the U.S. and around the world. In many undeveloped nations, obesity is already a greater health threat than malnutrition.
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  Willett disputes studies purporting to show a relationship between being underweight and heightened health risks. There is a chicken and egg problem, here, since smoking and many illnesses cause people to be underweight. The increase in illness tends to disappear in studies of initially healthy nonsmokers.
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  The standard Body Mass Index of healthy weight is criticized by the author. The upper boundary of the healthy range is too high, he asserts. Also, the amount of weight gained after the early twenties - even if still in the healthy range - can have a major impact on health prospects. A waist that expands more than two or three inches over the years is a warning of health trouble.

  "In two long-term Harvard studies, the Nurses' Health Study and the Health Professionals Follow-up Study, middle-aged men and women who had gained between eleven and twenty two pounds after age twenty were up to three times as likely to develop heart disease, high blood pressure, type 2 diabetes, and gallstones as their counterparts who gained five pounds or less. Larger weight gains meant even higher chances of developing these diseases."

  Genetic predisposition, diet, lifestyle, and the culture of consumption all play roles in the obesity epidemic.
 &

  Many of the popular diet fads are viewed critically by the author. The key is to limit calories consumed and increase calories burned through activity until a healthy balance is reached. Increased exercise has many health benefits besides weight control. A diet that is otherwise healthy and is satisfying is also essential for maintenance of a healthy balance.
 &

The "glycemic index" - long used by diabetics - is a useful tool for weight control diets.

  However, foods that are rapidly absorbed cause sharp spikes in blood sugar and insulin responses. This then causes rapid declines in blood sugar that stimulate feelings of hunger and increase tendencies to snack between meals.
 &
  Thus, avoidance of sugar, potatoes, and refined rice and wheat and other easily digested foods, and reliance instead on fruits and vegetables, beans, and whole grain rice and whole wheat breads, is an important part of a satisfying weight control diet. The "glycemic index" - long used by diabetics - is a useful tool for weight control diets.
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  The author is justifiably dubious about high protein, low carbohydrate diets. These have not been adequately tested for long term health impacts, and may cause more harm than good.
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A good brisk daily walk of at least 30 minutes is all that is needed to achieve most of the benefits of exercise. However, this has to be maintained. "The physical and physiological changes wrought by decreased muscle mass and increased weight are tough to reverse and in some cases may be irreversible."

  As we age, there is a natural tendency to lose muscle and gain fat as a result of inactivity and reductions of sex hormones. "The less muscle you have, the less energy your body uses at rest and the easier it is to gain weight." Indeed, the lost muscle is often replaced by fat.
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  This unhealthy cycle can only be broken with exercise. While strenuous exercise may have some additional benefits, a good brisk daily walk of at least 30 minutes is all that is needed to achieve most of the benefits of exercise. However, this has to be constantly maintained. "The physical and physiological changes wrought by decreased muscle mass and increased weight are tough to reverse and in some cases may be irreversible."
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  Preventing weight gain is thus much easier than losing excess weight - and the bad health impacts of excess weight - once initiated - may not disappear even if the excess weight is lost.
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  A variety of well known tips for successful diets are listed.

Fats:

 

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  The conditions associated with fatty foods have become increasingly prevalent despite efforts to reduce fat intake. Overweight and diabetes keep increasing. Fat consumption in the average American diet has been reduced from 40% to 34% of total calories without achieving any apparent impact on cancer rates and heart attacks from coronary artery blockages.
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The real objective is an adequate intake of the good fats and reduced consumption of the bad fats rather than a total reduction of all fats.

 

Holding calories constant will prevent any weight gain from the increased consumption of good fats.

  That's because there are good fats and bad fats, and much of the decline in fat consumption has been in intake of good fats. The real objective is an adequate intake of the former and reduced consumption of the latter rather than a total reduction of all fats.
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  Smoking is the leading cause of coronary artery blockages, but excess weight and inactivity are also major causes. "But after not smoking, controlling the type of fat you eat is one of the most important ways to prevent heart disease."
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  The objective is to reduce saturated and trans fats while increasing consumption of monounsaturated and polyunsaturated fats - but without any increase in calorie intake. Holding calories constant will prevent any weight gain from the increased consumption of good fats.

  "[Good fats] influence how much high-density lipoprotein (HDL), the so-called good or protective cholesterol, is in your bloodstream, how your blood clots, how susceptible your heart is to erratic rhythms, how the inner lining of blood vessels responds to stress, and probably other pathways to heart disease we haven't yet discovered."

Total fat reduction diets also may reduce intake of such foods as nuts, avocadoes, salad dressings made with unsaturated oils - all of which contain beneficial fats as well as vitamin E and other valuable nutrients.

 

Good fats are so important, that they form part of the foundation of the Healthy Eating Pyramid.

  Again, the USDA Food Guide Pyramid gets it wrong - putting good and bad fats together at the top of the pyramid in the "use sparingly" category. Other guidelines simplistically emphasize the need to reduce saturated fats and to moderate intake of total fats, but omit the benefits of unsaturated fats. The Dietary Guidelines for Americans, and dietary guidelines from the American Heart Association, the American Cancer Society, the American Society for Clinical Nutrition, the American Dietetic Association, the American Academy of Pediatrics, and the National Institutes of Health all omit that "eating unsaturated fats instead of saturated fats can improve the levels of cholesterol and other fat particles in your blood, fortify your heart against erratic heartbeats or help counteract a number of processes that make up atherosclerosis, the gradual clogging and narrowing of arteries."
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  Replacing saturated fat with carbohydrates - "usually simple or highly processed carbohydrates such as sugar, pasta, white rice and potatoes" - will usually achieve small reductions in total cholesterol, but "it also lowers levels of HDL (good) cholesterol." Increased carbohydrates "increase weight every bit as effectively as fats if you consume more calories than you burn off."
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  Simple and highly processed carbohydrates also spike blood sugar and insulin levels - something that doesn't happen with fat, protein,  fruits and vegetables, and slowly absorbed carbohydrates such as whole grains. Total fat reduction diets also may reduce intake of such foods as nuts, avocadoes, salad dressings made with unsaturated oils - all of which contain beneficial fats as well as vitamin E and other valuable nutrients.
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  Good fats reduce harmful low-density lipoprotein (LDL), prevent an increase in triglycerides, and reduce incidence of erratic heartbeats and artery blocking clots. They are so important, that they form part of the foundation of Willett's Healthy Eating Pyramid.
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  Monounsaturated and polyunsaturated fats are liquid at room temperature - saturated fats are solid. "Our bodies don't make polyunsaturated fats, so we need to get these essential fats from plants, oils like corn and soybean oil, seeds, whole grains, and fatty fish such as salmon and tuna."
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Trans fats are man made - and are the worst fats.

  Trans fats are man-made fats such as margarine or Crisco that may be liquid or solid and are bad for your heart. They are the worst fats.
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  Such foods as fast food French fries, packaged breads and cookies, with "partially hydrogenated vegetable oil" or "vegetable shortening" on the label contain trans fats. Even products labeled "trans fatty acid free" can have some if they have "partially hydrogenated vegetable oils." They raise LDL (bad) cholesterol, lower HDL (good) cholesterol, increase triglycerides and lipoprotein (a) - another substance linked with heart disease - and make blood platelets stickier and more likely to clot.
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  Eggs are high in cholesterol, but low in saturated fats and high in many good nutrients. Except for people with diabetes, "[n]o research has ever shown that people who eat more eggs have more heart attacks than people who eat few eggs."
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Diet can lead to as much as a 70% decrease in risk of heart disease.

 

It is neither necessary nor possible to eliminate all saturated fats. Eating saturated fats "in the right proportion with unsaturated fats is perfectly fine."

  The many essential functions of fats and cholesterol - and the bad affects of LDL and high levels of triglycerides - are briefly reviewed in the book. It is calculated from recent studies that "replacing 5 percent of total calories as saturated fat with unsaturated fat would reduce the risk of heart attack or death from heart disease by about 40 percent," and "replacing just 2 percent of total calories from trans fats with the same number of calories from unsaturated fats would cut the risk by 50 percent." Diet can lead to as much as a 70% decrease in risk of heart disease.
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    It is neither necessary nor possible to eliminate all saturated fats. Eating saturated fats "in the right proportion with unsaturated fats is perfectly fine." Unsaturated fats can be found in canola, olive, sunflower, corn and soybean oils, and in soybeans and soy products and nuts. Chicken fat has a far better balance between healthy and unhealthy fats than beef fats.
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  Willett is especially critical of Olestra - an indigestible fat substitute marketed by Procter & Gamble as "Olean." This substance is designed to pass through the digestive tract without being absorbed. However, it soaks up fat-soluble vitamins and other phytochemicals and carries them away, too. These include vitamins A, D, E and K and beta-carotene, lycopene, "and a host of other plant pigments and phytochemicals" which can't get into the bloodstream except aboard fat molecules. Olestra has been banned in Canada.
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  Other fat substitutes, such as oatrim and Simplesse, do not seem to have such defects - but do not solve the problem of achieving a healthy mix of healthy and unhealthy fats with a diet without excess calories.
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The n-3 fatty acids:

 

The omega-3 fatty acids are essential nutrients that the body can't make from scratch.

  The n-3 polyunsaturated fatty acids - also called omega-3 fatty acids - are essential nutrients that the body can't make from scratch. Benefits include reduced risks for heart disease, stroke and autoimmune problems. N-3 fatty acids are especially important for brain and nervous system development in fetuses and babies. Cell membranes and some hormones need n-3 fatty acids.
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  The n-6 fatty acids - which comprise the more numerous polyunsaturated fats in our diet - help shape healthy cholesterol levels and reduce heart disease risks.
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  The best sources for the n-3 fatty acids are fish, flaxseeds, walnuts, and canola and unhydrogenated soybean oils. Most vegetable oils high in linolenic acid are good sources. Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are other n-3 fatty acids.
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  The link between fat intake and cancer is weak at most. Too many calories - from any sources - are far more strongly linked to cancer. Thus, cancer risk is not an obstacle to an increase in consumption of good fats.
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Carbohydrates:

  Carbohydrates are the most important constituent of the diet. They generally provide the lions share of the calories - about half - have the most impact on weight, and wield the greatest control over blood sugar. As with fats, the type of carbohydrates consumed is important.
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As a sedentary population cuts back on fats but eats more carbohydrates, obesity and diabetes rates soar and the decline in heart disease rates slows.

 

Refined carbohydrates are quickly digested and absorbed, with damaging consequences that include "higher levels of blood sugar, insulin, and triglycerides, and lower levels of HDL cholesterol."

 

"The low-fat, high-carbohydrate diet recommended by the National Cholesterol Education Program and the USDA Food Guide Pyramid may be among the worst eating strategies for  someone who is overweight and not physically active."

  Eating grains "that are as intact and unprocessed as possible," along with fruits and vegetables, is as important for health as consuming the right kind of fats. This fact is missed by the American Heart Association, the American Cancer Society, the World Health Organization, - and, of course - the USDA Food Guide Pyramid. As a sedentary population cuts back on fats but eats more carbohydrates, obesity and diabetes rates soar and the decline in heart disease rates slows.
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  Refined carbohydrates are quickly digested and absorbed, with damaging consequences that include "higher levels of blood sugar, insulin, and triglycerides, and lower levels of HDL cholesterol." This means more cardiovascular disease and diabetes.
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  Exercise is a key factor, Willett emphasizes. A hard working Chinese population has no problem with a high carbohydrate diet, but an increasingly sedentary population in Beijing has recently experienced a huge increase in diabetes rates. Exercised muscle cells handle insulin and glucose very efficiently.  Obesity, inactivity, dietary trans fats, and genetic predisposition all play greater or lesser roles in this process. Blood sugar problems also play a role in low HDL (good) cholesterol - high blood pressure - and high levels of triglycerides, heart disease and possibly some forms of cancer. These tendencies appear to be far worse for overweight people than for lean people.

  "Put more plainly, the low-fat, high-carbohydrate diet recommended by the National Cholesterol Education Program and the USDA Food Guide Pyramid may be among the worst eating strategies for  someone who is overweight and not physically active."

  Even for lean people, a switch to whole grains will provide highly beneficial micronutrients. Fiber, antioxidants, phytoestrogens, and a variety of minerals in bran, are some of the most important elements lost or substantially reduced in the refining process. Adding bran and wheat germ helps, but still doesn't prevent the rapid absorption of the starch in refined grains.
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Most calories in the average U.S. diet come from sugars or highly refined grains. These are quickly absorbed, quickly increase blood sugar and thus insulin levels. The demands on the pancreas for sudden surges in insulin may lead to systemic insulin resistance, increased insulin demand, and type 2 diabetes.

 

 

 

 

  Willett divides carbohydrates by their impact on blood sugar - "the glycemic index" - and by whether they come from whole or refined grains - rather than by whether they are "simple" or "complex." Unfortunately, most calories in the average U.S. diet come from sugars or highly refined grains. These are quickly absorbed, quickly increase blood sugar and thus insulin levels.  The demands on the pancreas for sudden surges in insulin may lead to systemic insulin resistance, increased insulin demand, and type 2 diabetes. Insulin surges rapidly reduce blood sugar levels and send hunger signals if this blood sugar roller coaster isn't modified by slower-digested whole grains. A more drawn out process means "it may take longer to get hungry again."
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  Cola beverages, white bread, white rice, French fries and cooked potatoes, all provide bad carbohydrates. Whole wheat bread, brown rice, whole grain pasta, kasha, quinoa, whole oats and bulgar, provide the right kind of carbohydrates.
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  Diabetes and heart disease - GI problems like constipation, diverticulitis and diverticulosis - and cancers of the mouth, stomach, colon, gallbladder and ovaries - are all substantially reduced by diets high in good carbohydrates. With cancers, it appears that it is the whole package of nutrients available in the whole grains that matters, rather than the impact on blood sugar. The book provides a variety of helpful hints for increasing your whole grain intake.
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Protein:

  Eating more protein from fish, chicken, and vegetable sources like beans and nuts - and less from red meats and dairy products - is also an important constituent of healthy eating habits.
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Willett recommends leaner cuts of red meats or - better - consumption of poultry or fish instead.

  However, vegetable protein is generally incomplete - lacking in some essential amino acids. Thus, it is important for vegetarians to eat combinations that compliment each other, such as rice and beans, peanut butter and bread, tofu and brown rice."
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  Willett states that there is as yet too little evidence to condemn red meat proteins, but notes that frying and grilling any animal protein does create some suspect chemicals, and red meats do contain substantial amounts of saturated fats. Thus, he recommends leaner cuts of red meats or - better - consumption of poultry or fish instead. Whole milk and whole milk dairy products also contain a lot of saturated fats.
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Proteins leach calcium - as the body reacts to neutralize protein-related acids. So, the long run impact of high protein diets on bone loss must be considered.

  High protein diets designed to reduce calorie intake from the wrong kinds of carbohydrates do help with blood sugar problems, reduce triglycerides, and boost HDL (good) cholesterol. There are many other claims for and against various proteins, but most remain unproven. However, allergy problems can be severe - especially for cows milk consumption by children. Also, proteins leach calcium - as the body reacts to neutralize protein-related acids. So, the long run impact of high protein diets on bone loss must be considered.
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  Soy products contain many important nutrients, and do seem to have a favorable impact on cholesterol levels. However, other health claims have not yet been scientifically proven. The phytoestrogens are certainly potent biological agents, but some of the impacts - especially for women fighting breast cancer - may be harmful. As with proteins from other sources, moderation appears to be the best policy.
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Fruits and vegetables:

  Fruits and vegetables reduce risks of heart attacks and strokes and a variety of cancers, lower blood pressure and bad cholesterol, help avoid diverticulitis, and cataracts and macular degeneration.
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The odds are high that the benefits of fruits and vegetables emanate from many different substances found in plants and quite possibly from the interaction of these substances.

 

Potatoes should not be included as a vegetable.

Pills are no substitute.

  "Plants make or sequester a seemingly endless cornucopia of compounds that have biological activity in the human body. The vast majority of these phytochemicals (literally, chemicals made by plants) have yet to be discovered, named, chemically characterized, and biologically evaluated. So far, only a tiny minority have been flagged as agents that may be responsible for the health benefits of fruits and vegetables, sometimes on the basis of surprisingly little solid evidence. The odds are high that the benefits previously listed emanate from many different substances found in plants and quite possibly from the interaction of these substances."

  Since no fruit or vegetable provides all of these substances, eating a variety of them is important. The five servings a day recommended by the authoritative guides should be viewed as a minimum, but potatoes should not be included in this calculation.
 &
  The book reviews specific benefits associated with specific fruits and vegetables and the beneficial nutrients so far identified. It recommends nine servings per day - including a variety of types and colors. At least one serving per day of each of the following: Dark green, leafy vegetables - yellow or orange fruits and vegetables - red fruits and vegetables - legumes (beans) - and citrus fruits.
 &
  Fresh is better than cooked. Heat destroys vitamin C and folic acid, among other things. However, cooking helps extract the beneficial lycopenes in tomatoes. Frozen can be nearly as good as fresh, and better than "fresh" fruits and vegetables stored for long periods in ways that prevent ripening.
 &

Fluids:

 

&

  About 8 eight-ounce glasses of fluid are needed per day, but much of this can be obtained from fruits and vegetables. Diet, physical activity and weather conditions vary this requirement. Meat and bread, physical activity, and hot weather and/or low humidity increase the need for fluids. The author advises enough fluid intake so the urine is "consistently clear or pale yellow rather than bright or dark yellow."
 &

 

Popular sodas have seven to nine teaspoons of sugar per 12 ounce can. This creates weight problems and stress for the pancreas.

  But urine color or even thirst are not always reliable guides. The book recommends one glass of fluid with each meal and one between meals.
 &
  Popular sodas have seven to nine teaspoons of sugar per 12 ounce can. This creates weight problems and stress for the pancreas. Sodas using artificial sweeteners are probably better, but there are so far unproven hints of dangers in these substances. (Repeatedly - like so many medical doctors - the author considers clinical proof to be no proof.)
 &

Milk has many problems, and is not recommended for more than occasional consumption.

 

In moderation, alcohol can reduce stress, improve digestion, improve emotional well being, reduce risks of heart disease and ischemic strokes, and perhaps even diabetes and gall stones. It helps raise HDL (good) cholesterol levels, and lowers risks of arterial clotting. However, even moderate consumption can disrupt sleep, interact dangerously with some medicines, and be addictive for some people.

 

 

Young men and young women gain little benefit from consumption of alcohol - and great benefit from exercise.

  Fruit and vegetable juices are much better than sodas, of course, but they add calories as well as nutrients, and so are another dietary element to be used in moderation. Willett advises dilute juices if substantial volumes are consumed. Other problems and benefits of various fluids include:

  • Grapefruit juice alters the way some people absorb certain medications. The book lists some of the known effects - some of which are quite serious. An association between grapefruit juice and kidney stones has also been found.
  • Milk has many problems. "I do not recommend it as a beverage for adults and believe you should think of milk as an optional food, not the two-to-three servings-a-day requirement described in the current USDA Food Guide Pyramid."
  • Coffee has several problems - including mild addiction, insomnia and bone loss. Most noticeable are the immediate emotional impacts when a coffee drinker doesn't get his regular fix. However, most of the earlier perceived health risks turned out to be associated with the smoking that frequently went along with coffee drinking, rather than with the coffee itself. Coffee actually has some health benefits, including fewer kidney and gall bladder stones, and lower suicide rates. This is yet another dietary substance to be used in moderation.
  • Tea has all the benefits of coffee, and perhaps more. Green tea may reduce some cancer risks, but the author expresses some doubts about this.

  Since the book was published, additional studies indicating beneficial health impacts for tea have been published.

  • Alcohol also appears to be useful in moderation, but is very damaging if consumed in substantial amounts. In moderation, it can reduce stress, improve digestion, improve emotional well being, reduce risks of heart disease and ischemic strokes, and perhaps even diabetes and gall stones. It helps raise HDL (good) cholesterol levels, and lowers risks of arterial clotting.

  Moderate consumption of alcohol is estimated as one drink per day for women - two for men. Also, folic acid intake seems to reduce the breast and colon cancer risk associated with moderate alcohol consumption. Even moderate consumption, however, can disrupt sleep, interact dangerously with some medications, and be addictive for some people.
 &
  Willett asserts that the benefits are the same for all alcoholic drinks - not just red wines. He also points out that the benefits are heavily modified by gender and age factors and other health factors, and that exercise provides the same benefits more effectively and with no side effects. Young men and young women gain little benefit from consumption of alcohol - and great benefit from exercise.
 &

Calcium:

  The appropriate level of calcium intake remains uncertain. Low intake of calcium isn't associated with increased risks of bone fractures. Other factors are much more important.
 &

Low intake of calcium isn't associated with increased risks of bone fractures. Other factors are much more important.

  The current conventional wisdom concerning dietary calcium is sharply criticized by Willett.

  "Unfortunately, there's little proof that just boosting your calcium intake to the high levels that are currently recommended will prevent fractures. And all the high-profile attention given to calcium is distracting us from strategies that really work -- like exercise, certain medications, and, for women, hormone replacement therapy."
 &
  In July, 2002, a major federal study found that long term hormone supplementation increased the risk of breast cancer, strokes and heart attacks sufficiently to force termination of the study. Hormone supplement usage has dropped sharply since last July. Of course, there are small amounts of hormone residues widespread in milk and red meat - but no "scientific" evidence about their impact.

There is virtually no evidence that drinking two or three glasses of milk a day reduces the chances of breaking a bone.

  The consumption of substantial amounts of milk or other dairy products as a means of boosting calcium intake is especially criticized. The author provides a page long list of foods - in addition to milk - that provide substantial amounts of calcium and magnesium. Greens such as collards and spinach, along with tofu and figs and oatmeal are the best sources, and don't have the problems of milk. (Try using fresh spinach instead of lettuce for your salad. You'll like it!)
 &
  Problems from milk and dairy products include:

  • Lactose intolerance,
  • saturated fat intake,
  • extra calories, and
  • possible increased risk of prostate or ovarian cancer.

    The author favors substituting nonfat plain yogurt for other dairy products like sour cream - and recommends both yogurt and cottage cheese as good sources of vitamin B12. (However, he offers no discussion of these cultured dairy products and how they differ from other dairy products.) He concludes:

 "The totality of evidence doesn't support the claim that just getting more calcium prevents fractures over the long term, and there is virtually no evidence that drinking two or three glasses of milk a day reduces the chances of breaking a bone. What's more, dairy products pose several proven and potential problems. So if you are worried about osteoporosis, other prevention strategies make better sense."

Protein digestion releases acids into the bloodstream and causes the body to draw on its calcium supplies to neutralize the acids. Animal proteins are somewhat more powerful than vegetable proteins at leaching calcium. The rate of bone fractures are higher in meat eating nations like the U.S.

  Reducing consumption of proteins that trigger the leaching of calcium out of the bones and into the bloodstream is a good place to start. Protein digestion releases acids into the bloodstream and causes the body to draw on its calcium supplies to neutralize the acids. Animal proteins are somewhat more powerful than vegetable proteins at leaching calcium. The rate of bone fractures are higher in meat eating nations like the U.S.
 &
  Exercise that puts stress on bones triggers bone growth - the effectiveness of which depends not just on the availability of calcium, but on hormonal factors and the availability of vitamins D and K as well.
 &
  Calcium intake studies have provided very dubious and conflicting results. This is not surprising, since many studies are short term and bone loss and fractures occur from long term problems. Also, other factors, such as exercise and vitamin D, play such an important role in the problem.
 &

Vitamins:

  The importance of food supplements for known dietary weaknesses - and the rapidly evolving recognition of nutrients inadequately provided by widespread dietary habits - are covered by Willett.
 &

The book cautions that many of the benefits attributed to such vitamins as the antioxidants may be more due to the entire package of nutrients supplied by whole foods like fruits and vegetables rather than just to the identified vitamins themselves.

 

Taking just single antioxidants is far less effective than consuming fruits and vegetables that provide whole packages of beneficial nutrients.

  However, the book cautions that many of the benefits attributed to such vitamins as the antioxidants may be more due to the entire package of nutrients supplied by whole foods like fruits and vegetables rather than just to the identified vitamins themselves.
 &
  Vitamins C and E, beta-carotene and related carotenoids,
and the minerals selenium and manganese are the primary antioxidants. Others include glutathione, coenzyme Q10, lipoic acid, flavonoids, phenols and phytoestrogens. Each play different roles, so just getting a few in pills is not enough. While complexities render the studies somewhat murky, it appears that taking just single antioxidants is far less effective than consuming fruits and vegetables that provide whole packages of beneficial nutrients.
 &
  Vitamin A has numerous vital roles, but is so readily available in the diet that further supplementation is not recommended unless there are specific medical reasons for it.
 &
  Carotenoids - beta-carotene, lycopene, alpha-carotene, lutein and zeaxanthin, and beta-cryptoxanthin are just a few of the approximately 500 known carotenoids - act as powerful and adaptable antioxidants or are transformed into vitamin A. Other important functions may be found in the future. However, here, too, there is no evidence that individual carotenoids are especially helpful. Here, too, it appears that the whole package of nutrients in fruits and vegetables is required for any widely beneficial impact.
 &
  Vitamin C, however, by itself, provides many benefits - in addition to preventing scurvy. However, the many studies have failed to demonstrate extra benefits from mega-doses, and there is some evidence that too much can be harmful.
 &
  Vitamin E, however,  may have to be taken in amounts equal to 800 International Units for full benefits. This is far in excess of what is generally available in a normal diet. Here, too, studies are murky, because many studies are short term or concentrate on sick people who are already taking various medicines and other treatments. The book notes a couple of reasons for caution having to do with people taking blood thinning medications or suffering from retinitis pigmentosa.
 &

Vegetarians and individuals with an inability to absorb natural B12 need B12 supplements. Liver, yogurt, cottage cheese and eggs are good natural sources.

  B Vitamins folic acid, B6 and B12 are required for proper metabolism of homocysteine. Poor metabolism of homocysteine results in cholesterol-clogged arteries.
 &
  The book accepts the current recommended daily intake of 400 micrograms of folic acid, 1.3 to 1.7 milligrams of B6, and 6 micrograms of B12. However, this is more than the average U.S. diet will provide.
 &
  There is some evidence that 50 to100 milligrams of B6 can have a variety of neurological benefits, but doses in excess of 250 milligrams can cause neurological damage.
 &
  B12 is an essential ingredient for making red blood cells. Deficiency can result in "an array of problems, including memory loss and dementia, muscle weakness, loss of appetite, and tingling in the arms and legs." B12 comes only from animal products. Vegetarians and individuals with an inability to absorb natural B12 need B12 supplements. Liver, yogurt, cottage cheese and eggs are good natural sources.
 &
  Folic acid helps build DNA, and thus may have a wide range of benefits. It even helps temper some of the problems from alcohol. It is so widely and clearly beneficial - especially for pregnant women, their fetuses and newborns - that all grain products are now fortified with folic acid. Liver, lentils, spinach and beans are good natural sources.
 &

Vitamin D is more important for prevention of bone fractures due to bone loss than is calcium. Those living north of San Francisco - Denver - Philadelphia do not get enough sunlight during winter months for the production of vitamin D.

 

Both too little and too much potassium can cause major problems, so supplementation is risky.

  Vitamin D makes sure that calcium and phosphorus are absorbed and retained, and apparently inhibits a variety of cancer cells. Vitamin D is more important for prevention of bone fractures due to bone loss than is calcium. Those living north of San Francisco - Denver - Philadelphia do not get enough sunlight during winter months for the production of vitamin D.
 &
  Fortified foods, and tuna, salmon and bluefish are good sources of vitamin D. Fifteen minutes in strong sunlight is best. Otherwise, a supplement is needed.
 &
  Vitamin K helps make six of the thirteen proteins needed for clotting. Some of these proteins are also involved in building bone. A daily serving of green leafy vegetables is recommended.
 &
  Calcium is certainly needed - at least 500 milligrams per day. However, the recommended daily intake of 1200 milligrams per day for adults over 50 is probably too high.
 &
  Iron is amply provided by the meat and iron-fortified grains in the U.S. diet. However, infants and women of child-bearing age may need some more. The recommended daily intake appears adequate. However, there may be some risk in getting too much iron from meat sources, as the body will retain that iron even if it is excessive. Too much iron retained by the body may pose some health risks.
 &
  Magnesium has a vast array of biological functions, and is readily available in the diet. Older people - those with trouble absorbing magnesium - and people taking diuretics or consuming large amounts of alcohol may be deficient in magnesium.
 &
  Potassium is widely available from bananas and other fruits and vegetables. Both too little and too much potassium can cause major problems, so supplementation is risky. Diuretics and heavy coffee consumption can cause low potassium levels. High blood pressure, muscle cramps and heart irregularities can be caused by low potassium levels.
 &

  Salt intake for the average person need be no more than one gram per day. Yet, the average meal provides two to five grams. Excess salt can cause high blood pressure.
 &
  Selenium
is a potent antioxidant, the precise benefits of which have not yet been scientifically proven. Low levels of selenium are found in people living in regions where soil levels are low.
 &
  Zinc lozenges have shown no ability to treat colds in recent studies. Nevertheless, there is no question that zinc plays an important role in immune system health, blood clotting, proper vision, wound healing, and sperm development.
 &
  Pregnant and lactating women need extra zinc for themselves and their nursing children. Sufficient zinc is important in the brain development and motor skills of children. Deficiency may play a role in hyperactivity and attention problems in children. Older people and heavy drinkers may need extra zinc.
 &
  But overdosing is dangerous and begins at just over the recommended 15 milligrams per day. So supplementation should be cautious. Red meat and poultry are good sources, but vegetarians seem to have no trouble with their lower zinc levels.
 &

A multivitamin is good insurance, but is no substitute for a healthy diet.

  The book advises taking a multivitamin as insurance against deficiencies - especially for folic acid, B6, B12, and Vitamins D and E. But it stresses that this is no substitute for a healthy diet.

  "A multivitamin can't in any way replace healthy eating. It gives you barely a scintilla of the vast array of healthful nutrients found in food. It doesn't deliver any fiber. Or taste. Or enjoyment. The only thing it can do is offer a nutritional backup or fill in the nutrient holes that can plague even the most conscientious eaters."

  Mineral supplementation is advised only in special cases, such as iron for women of child bearing age.
 &

  The book concludes by recommending disregard for the advice embodied in the USDA Food Guide Pyramid and reliance instead on the book's Healthy Eating Pyramid. This includes, among other things,

  • "maintaining a stable, healthy weight;
  • replacing saturated and trans fats with unsaturated fats;
  • substituting whole-grain carbohydrates for refined-grain carbohydrates;
  • choosing healthier sources of proteins by [replacing] red meat [with] nuts, beans, chicken, and fish;
  • eating plenty of vegetables and fruits;
  • using alcohol in moderation;
  • taking a daily multivitamin for insurance."

  Sources for whole grain and organic and natural foods - dietary advice - and recipes - fill about the last 90 pages of the book. The recipes cover snacks, a full week of menus, and a wide variety of specialty dishes.

  Fruit provides the best snacks. For between meals, try keeping a bowl of grapes in the refrigerator. Grabbing a few grapes from time to time will satisfy the need to put something tasty in your mouth without busting your diet. For a late night snack that will digest easily enough so that it won't keep you awake, try an orange or a banana.

  Before the age of 40, health is a gift from God. After the age of 40, health is something you earn.

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Copyright 2002 Dan Blatt