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Eat, Drink, and Be Healthy: The Harvard Medical School Guide to Healthy Eating Paperback – July 7, 2005
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Dr. Walter Willett’s research is rooted in studies that tracked the health of dieters over twenty years, and in this groundbreaking book, he critiques the carbohydrate-laden diet proposed by the USDA.
Exposing the problems of popular diets such as the Zone, South Beach, and Atkins, Dr. Willett offers eye-opening research on the optimum ratio of carbohydrates, fats, and proteins, and the relative importance of various food groups and supplements. Find out how to choose wisely between different types of fats, which fruits and vegetables provide the best health insurance, and the proportions of each to integrate into their daily diet.
- Print length352 pages
- LanguageEnglish
- PublisherFree Press
- Publication dateJuly 7, 2005
- Dimensions5.5 x 0.9 x 8.44 inches
- ISBN-100743266420
- ISBN-13978-0743266420
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Editorial Reviews
Review
-- Timothy Johnson, M.D., M.P.H., medical editor, ABC News
"Finally, a commonsense, science-based book on nutrition that you can trust!"
-- Susan Love, author of Dr. Susan Love's Breast Book and Dr. Susan Love's Hormone Book
About the Author
Excerpt. © Reprinted by permission. All rights reserved.
We eat to live.
It's a simple, obvious truth. We need food for the basics of everyday life -- to pump blood, move muscles, think thoughts.
But we can also eat to live well and live longer. By making the right choices, you will help yourself avoid some of the things we think of as the inevitable penalties of getting older. A healthy diet teamed up with regular exercise and no smoking can eliminate 80 percent of heart disease and 70 percent of some cancers. Making poor choices -- eating too much of the wrong kinds of food and too little of the right kinds, or too much food altogether -- increases your chances of developing cancer, heart disease, diabetes, digestive disorders, and aging-related loss of vision. An unhealthy diet during pregnancy can even cause some birth defects.
Separating what's good from what's bad can be a discouraging task. Each day you have to choose from an ever increasing number of foods and products, some good, most not so good. Maybe the time you have to prepare food, or even to eat, seems to shrink by the month. To make matters worse, you may feel overwhelmed by contradictory advice on what to eat. Your daily newspaper or TV newscast routinely serves up results from the latest nutrition studies. Magazines trumpet the hottest diets complete with heartfelt testimonials. One new diet or nutrition book hits the bookshelves every other day. Even supermarkets and fast-food restaurants offer advice, as do cereal boxes and a sea of Internet sites. This jumble of information quickly turns into nutritional white noise that many people tune out.
TURNING TO THE USDA PYRAMID IS A MISTAKE
For no-nonsense, rock-solid nutrition information, people often look to the Food Guide Pyramid developed by the U.S. Department of Agriculture (USDA). It is supposed to offer straight talk that rises above the jungle of misinformation and contradictory claims.
That's a shame, because the USDA Pyramid is wrong. It was built on shaky scientific ground back in 1992. Since then it has been steadily eroded by new research from all parts of the globe. Scores of large and small research projects have chipped away at the foundation (carbohydrates), the middle (meat and milk), and the apex (fats). The Dietary Guidelines for Americans, which are supposed to serve as the detailed blueprint for the USDA Pyramid, are a bit better. They are updated every five years and sometimes include ready-for-prime-time research. But the USDA Pyramid hasn't really changed in spite of important advances in what we know about nutrition and health.
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.
REBUILDING THE FOOD PYRAMID
I wrote this book to show you where the USDA Pyramid is wrong and why it is wrong. I wanted to offer a new healthy eating guide based on the best scientific evidence, a guide that fixes the fundamental flaws of the USDA Pyramid and helps you make better choices about what you eat. I also wanted to give you the latest information on new discoveries that should have profound effects on our eating patterns.
The Healthy Eating Pyramid is just as simple as the USDA Food Guide Pyramid. You don't have to weigh your food or tally up fat grams. There are no complicated food exchange tables to follow. You needn't eat odd combinations of foods or religiously avoid a particular type of food. Instead, our pyramid aims to nudge you toward eating mostly familiar foods that have been shown to improve health and reduce the risk of chronic disease. It involves simple changes you can make one at a time. Because it's an eating strategy aimed at improving your health instead of a diet aimed solely at helping you shed pounds, and because the changes suggested in this book can make your meals and snacks tastier, it is something you can stick with for years.
The Healthy Eating Pyramid isn't a single cute idea dolled up in a catchy graphic. It is the distillation of evidence from many different lines of research. This shouldn't be an important point, but it is. Few of the diets used by millions of Americans today are built on this kind of solid evidence. That was certainly clear from the "Great Nutrition Debate" sponsored by the USDA in February 2000. It brought together several authors of best-selling diet books for a lively, but mostly evidence-free, food fight. The wildly different recommendations presented in that three-hour session -- eat lots of meat, don't eat any meat, eat lots of carbohydrates, don't eat any carbohydrates, cut your intake of fat to under 20 percent of calories, eat as much fat as you want, stay away from sugar, eat potatoes -- neatly captured the chaos that we get in place of sound, sensible, and solid advice on healthy eating. This jumble of contradictions prompted USDA undersecretary Shirley Watkins to say afterward, "We will stand behind the Pyramid." But the USDA Pyramid isn't much better than most of these unsubstantiated diets!
THE HOLES IN THE USDA PYRAMID
Some recommendations on diet and nutrition are misguided because they are based on inadequate or incomplete information. Not the USDA Pyramid. It is wrong because it ignores the evidence that has been carefully assembled over the past forty years. Here are the USDA Pyramid's main and most health-damaging faults:
All fats are bad. There's no question that two types of fat -- saturated fat, the kind that's abundant in whole milk or red meat, and trans fats, which are found in many margarines and vegetable shortenings -- contribute to the artery-clogging process that leads to heart disease, stroke, and other problems. But the USDA Pyramid's recommendation to use fats "sparingly" ignores the fact that two other kinds of fat -- the monounsaturated and polyunsaturated fats found in olive oil and other vegetable oils, nuts, whole grains, other plant products, and fish -- are good for your heart.
All "complex" carbohydrates are good. Carbohydrates form the base of the USDA Pyramid. It suggests six to eleven servings of bread, cereal, rice, and pasta a day. But as with fats, this advice is too simplistic and overlooks essential research showing that the types of carbohydrates you eat matters a lot.
Most dietary guidelines recommend limiting simple carbohydrates (sugars) and eating plenty of complex carbohydrates (starches). White bread, potatoes, pasta, and white rice all fit this description and are the main sources of carbohydrates in the American diet. While the terms simple and complex have a specific chemical meaning, they don't mean much inside your body. In fact, your digestive system turns white bread, a baked potato, or white rice into glucose and pumps this sugar into the bloodstream almost as fast as it delivers the sugar in a cocktail of pure glucose. Swift, high spikes in blood sugar are followed by similar surges in insulin. As all this insulin forces glucose into muscle and fat cells, blood sugar levels plummet, triggering the unmistakable signals of hunger. To make matters worse, these high levels of blood sugar and insulin surges are now implicated as part of the perilous pathway to heart disease and diabetes. The harmful effects of these rapidly digested carbohydrates are especially serious for people who are overweight.
The carbohydrates that should form the keystones of a healthy diet come from whole grains, like brown rice or oats, from foods made with whole grains, like whole-wheat pasta or bread, or from beans. Your body takes longer to digest these carbohydrate packages, especially when they are coarsely ground or intact. That means they have a slow, low, and steady effect on blood sugar and insulin levels, which protects against heart disease and diabetes. They make you feel full longer and so keep you from getting hungry right away. They also give you important fiber plus plenty of vitamins and minerals.
The central message in the USDA Pyramid is that you should feel good about eating carbohydrates, especially if you are eating them in place of fats. But if you eat too much of the wrong kinds of carbohydrates and too little of the good kinds of fats, you can set yourself up for the same problems you may be trying to solve.
Protein is protein. The protein group occupies one of the upper chambers of the USDA Pyramid. You need this type of nutrient every day and can get it from a variety of sources. The USDA Pyramid serves up as equals red meat, poultry, fish, eggs, beans, and nuts. All are excellent sources of protein. But red meat is a poor protein package because of all the saturated fat and cholesterol that come along. Red meat may also give you too much iron in a form you absorb whether you need it or not. Chicken and turkey give you less saturated fat. The same is true for fish, which delivers some important unsaturated fats as well. As protein sources, beans and nuts have some advantages over animal sources. They give you fiber, vitamins, minerals, and healthy unsaturated fats. Like fruits and vegetables, they also give you a host of phytochemicals, an ever expanding collection of plant products that help protect you from a variety of chronic diseases.
Dairy products are essential. The USDA Pyramid includes two to three servings of dairy products a day. It's a message that the hip "Got Milk?" and even hipper "milk mustache" ads (all sponsored by the dairy industry) hammer home to every possible demographic group. As a prime source of calcium, dairy products have been enlisted to fight the so-called calcium emergency that is threatening Americans' bones. Only there isn't a calcium emergency. Americans get more calcium than the residents of almost every other country except Holland and the Scandinavian countries. And despite plenty of urgent public service announcements, there's little evidence that getting high amounts of calcium prevents broken bones in old age. Further complicating the issue are some studies suggesting that drinking or eating a lot of dairy products may increase a woman's chances of developing ovarian cancer or a man's chances of developing prostate cancer.
If you need extra calcium, there are cheaper, easier, and healthier ways to get it than dairy products. Whole-milk dairy products are loaded with the kind of saturated fat that is most powerful at raising cholesterol levels. One percent and skim milk are clearly better choices. Spinach, broccoli, tofu, and calcium-fortified orange juice and breakfast cereals are good sources of calcium and have other advantages -- they are lower in unhealthy fat than most dairy products, and they give you many extra nutrients. Finally, dairy products are an expensive way to get calcium. Calcium supplements or calcium-based antacids cost pennies a day (and they are mostly calorie-free, to boot) compared with up to a dollar a day for two to three servings of dairy products.
Eat your potatoes. According to the USDA, the average American eats 140 pounds of potatoes a year, making the spud the most popular vegetable in America. It is one of the few vegetables to be mentioned by name in the Dietary Guidelines -- except it shouldn't be classified as a vegetable. Potatoes are mostly starch -- easily digested starch at that -- and so should be part of the carbohydrate group. While more than two hundred studies have shown that people who eat plenty of fruits and vegetables decrease their chances of having heart attacks or strokes, of developing a variety of cancers, or of suffering from constipation or other digestive problems, the same body of evidence shows that potatoes don't contribute to this benefit.
Nutritionists and diet books alike often call potatoes a "perfect food." But while eating potatoes on a daily basis may be fine for lean people who exercise a lot or who do regular manual labor, for everyone else potatoes should be an occasional food consumed in modest amounts, not a daily vegetable. The venerable baked potato increases levels of blood sugar and insulin more quickly and to higher levels than an equal amount of calories from pure table sugar. French fries as they are usually sold do much the same thing, while also typically packing an unhealthy wallop of trans fats.
No guidance on weight, exercise, alcohol, and vitamins. Like the Sphinx, the USDA Pyramid is silent on four things you need to know about -- the importance of not gaining weight, the necessity of daily exercise, the potential health benefits of a daily alcoholic drink, and what you can gain by taking a daily multivitamin.
HOW THE USDA PYRAMID GOT ITS SHAPE
In Rudyard Kipling's classic children's story, the satiable Elephant's Child got its long trunk in a terrific tug-of-war, with Crocodile clamped on to its nose and Bi-Coloured-Python-Rock-Snake wrapped around its legs. That's pretty much how the USDA Pyramid got its structure -- yanked this way and that by competing powerful interests, few of which had your health as a central goal.
The thing to keep in mind about the USDA Pyramid is that it comes from the Department of Agriculture, the agency responsible for promoting American agriculture, not from agencies established to monitor and protect our health, like the Department of Health and Human Services, or the National Institutes of Health, or the Institute of Medicine. And there's the root of the problem -- what's good for some agricultural interests isn't necessarily good for the people who eat their products. (This schizophrenic split 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.)
Serving two masters is tricky business, especially when one of them includes persuasive and well-connected representatives of the formidable meat, dairy, and sugar industries. 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.
THIS HEALTHY EATING PYRAMID IS BASED ON SCIENCE
You deserve more accurate, less biased, and more helpful information than that found in the USDA Pyramid. I have tried to collect exactly that in the Healthy Eating Pyramid. Without question, I have the advantage of starting with a lot more information than the USDA Pyramid builders had ten years ago. Equally important, I didn't have to negotiate with any special-interest groups when it came time to design this Pyramid.
The Healthy Eating Pyramid isn't set in stone. I don't have all the answers, nor can I predict what nutrition researchers will turn up in the decade ahead. But I can give you a solid sense of state-of-the-art healthy eating today and point out where things are heading. This isn't the only alternative to the USDA Food Guide Pyramid. The Asian, Latin, Mediterranean, and vegetarian pyramids promoted by Oldways Preservation and Exchange Trust are also good, evidence-based guides for healthy eating. But the Healthy Eating Pyramid takes advantage of even more extensive research and offers a broader guide that is not based on a specific culture.
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. In the chapters that follow, I will lay out the evidence that shaped this blueprint for healthy eating and will also chart out extra information to help people with special nutritional needs get the most benefit from what they eat. These people include pregnant women, older people, and people with, or at high risk of, heart disease, diabetes, high cholesterol, high blood pressure, and some other chronic conditions.
For now, though, the following list of the seven healthiest changes you can make in your diet offers an overview that describes how the Healthy Eating Pyramid differs from the USDA Pyramid. Topping the list is controlling your weight.
Watch your weight. When it comes to long-term health, keeping your weight from creeping up on you is more important than the exact ratio of fats to carbohydrates or the types and amounts of antioxidants in your food. The lower and more stable your weight, the lower your chances of having or dying from a heart attack, stroke, or other type of cardiovascular disease; of developing high blood pressure, high cholesterol, or diabetes; of being diagnosed with postmenopausal breast cancer, cancer of the endometrium, colon, or kidney; or of being afflicted with some other chronic condition. Yes, it is possible to be too thin, as in the case of anorexia nervosa, but otherwise very few American adults fall into this category.
Eat fewer bad fats and more good fats. One of the most striking differences is the placement of healthy fats in the foundation of the Healthy Eating Pyramid instead of relegating all fats to the "Use Sparingly" spot at the top. The message here is almost as simple as the USDA's and far better for you: Fats from nuts, seeds, grains, fish, and liquid oils (including olive, canola, soybean, corn, sunflower, peanut, and other vegetable oils) are good for you, especially when you eat them in place of saturated and trans fat.
The all-fat-is-bad message has started a huge national experiment, with us as the guinea pigs. As people cut back on fat, they usually eat more carbohydrates. In America today, that means more highly refined or easily digested foods like sugar, white bread, white rice, and potatoes. This switch usually fails to yield the hoped-for weight loss or lower cholesterol levels. Instead it often leads to weight gain and potentially dangerous changes in blood fats -- lower high-density lipoprotein (HDL), the so-called good or protective cholesterol, and higher triglycerides (a major type of blood fat).
Substituting unsaturated fats for saturated fats, though, improves cholesterol levels across the board. It may also protect the heart against rhythm disturbances that can end in sudden death.
The bottom line is this: It is perfectly fine to get more than 30 percent of your daily calories from fats as long as most of those fats are unsaturated. The Healthy Eating Pyramid highlights the importance of keeping saturated and trans fats to a minimum by putting red meat, whole-milk dairy products, butter, and hydrogenated vegetable oils in the "Use Sparingly" section at the top.
Eat fewer refined-grain carbohydrates and more whole-grain carbohydrates. The Healthy Eating Pyramid has two carbohydrate building blocks -- whole grains that are slowly digested as part of the foundation and highly refined, rapidly digested carbohydrates at the very top.
For almost twenty years our research team has been one of several groups studying the health effects of foods made from refined and intact grains. The result of this work is compelling. Eating lots of carbohydrates that are quickly digested and absorbed increases levels of blood sugar and insulin, raises levels of triglycerides, and lowers levels of HDL cholesterol. Over the long run, these changes lead to cardiovascular disease and diabetes. In contrast, eating whole-grain foods is clearly better for long-term good health and offers protection against diabetes, heart disease, cancer, and gastrointestinal problems such as diverticulosis and constipation. Other research around the world points to the same conclusions.
Choose healthier sources of proteins. In the Healthy Eating Pyramid, red meat occupies the pointy tip to highlight the fact that something about red meat -- its particular combination of saturated fats or the potentially cancer-causing compounds that form when red meat is grilled or fried -- is connected to a variety of chronic diseases. In this pyramid, the best sources of protein are beans and nuts, along with fish, poultry, and eggs. It separates vegetable and animal protein sources and makes the latter optional for people who want to follow a vegetarian diet.
Eat plenty of vegetables and fruits, but hold the potatoes. Vegetables and fruits are essential ingredients in almost every cuisine. If you let them play starring roles in your diet, they will reward you with many benefits besides great taste, terrific textures, and welcome variety. A diet rich in fruits and vegetables will lower your blood pressure, decrease your chances of having a heart attack or stroke, help protect you against a variety of cancers, guard against constipation and other gastrointestinal problems, and limit your chances of developing aging-related problems like cataracts and macular degeneration, the most common causes of vision loss among people over age sixty-five. I've plucked potatoes out of the vegetable category and put them in the "Use Sparingly" category because of their dramatic effect on levels of blood sugar and insulin.
Use alcohol in moderation. When the first reports appeared linking moderate alcohol consumption with lower rates of heart disease, many scientists thought that some other habit shared by drinkers, not the drinking, accounted for the benefit. Today the evidence strongly points to alcohol itself. Based on the best estimates available, one drink a day for women and one or two a day for men cuts the chances of having a heart attack or dying from heart disease by about a third and also decreases the risk of having a clot-caused (ischemic) stroke.
Like many drugs, alcohol's effects depend on the dose. A little bit can be beneficial. A lot can eventually destroy the liver, lead to various cancers, boost blood pressure, trigger so-called bleeding (hemorrhagic) strokes, progressively weaken the heart muscle, scramble the brain, harm unborn children, and damage lives.
The clear and ever present dangers of alcohol and alcohol addiction make the recommendation of moderate drinking a political hot potato. While I acknowledge the problems with alcohol, I think it is important to point out its possible benefits for middle-aged and older people.
If you don't drink alcohol, you shouldn't feel compelled to start. You can get similar benefits by beginning to exercise (if you don't already) or boosting the intensity and duration of your physical activity, in addition to following the eating strategy we describe. But if you are an adult with no history of depression or alcoholism who is at high risk for heart disease, a daily alcoholic drink may help reduce that risk. This is especially true for people with type 2 diabetes or those with low HDL that just won't budge upward with diet and exercise. If you already drink alcohol, keep it moderate.
Take a multivitamin for insurance. Several of the ingredients in a standard multivitamin -- especially vitamins B6 and B12, folic acid, and vitamin D -- are essential players in preventing heart disease, cancer, osteoporosis, and other chronic diseases. At about a nickel a day, a multivitamin is a cheap and effective genuine "life insurance" policy. It won't make up for the sins of an unhealthy diet, but it can fill in the nutritional holes that can plague even the most conscientious eaters. A daily multivitamin is especially important for people who have trouble absorbing vitamins from their food and for those who can't, or don't, get out in the sun every day. A daily multivitamin is also important for people who drink alcohol because it provides extra folic acid. Alcohol interferes with the metabolism of this key vitamin.
USDA PYRAMID AND DIETARY GUIDELINES FAIL THE HEALTH TEST
Throughout this book I will talk about "the evidence." I hope I won't sound like an old, scratched record, repeating that there is or is not enough evidence on the benefits or risks of this or that strategy. But the evidence is what matters. Without it, recommendations are little more than opinions and educated guesses, and they may or may not accomplish what they set out to do.
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.
A few years ago, the USDA's Center for Nutrition Policy and Promotion devised a score sheet called the Healthy Eating Index "to measure how well American diets conform to recommended healthy eating patterns." This index assigns scores of 0 to 10 for each of ten dietary components. Five come from the USDA Pyramid (number of daily servings of grains, vegetables, fruits, meat, and dairy products), and five come from the Dietary Guidelines for Americans (total fat in the diet, percentage of calories from saturated fat, cholesterol intake, sodium intake, and variety of the diet). A score of 100 would mean perfect adherence to the USDA's recommendations, while a score of 0 would mean total disregard for them.
My colleagues and I used the government's Healthy Eating Index to test whether people who follow the recommendations laid out in the USDA Pyramid are healthier than those who don't follow these guidelines. They aren't. Among over 121,000 female nurses who are participating in a long-term study of diet you'll be hearing more about in later chapters, those with the highest scores on the Healthy Eating Index were no less likely to develop a major illness or die than those with the lowest scores over a twelve-year period. Women scoring high on the Healthy Eating Index were only slightly less likely to have a heart attack. The pattern was similar for more than 50,000 male health professionals participating in a separate long-term study.
These dismal results shouldn't come as a surprise since the USDA Pyramid ignores the extensive body of evidence linking certain eating patterns with long-term health. Instead they should be a warning that the current USDA Pyramid won't help you eat to live well or live longer.
To be fair, we are now in the process of testing the Healthy Eating Pyramid. Because each of its building blocks comes from the finest possible quarry -- solid evidence amassed by researchers from around the world -- it has already passed the most important tests. I'm confident that the findings from this research will show that it can help keep you healthy.
WHAT'S IN THIS BOOK
Between the covers of this book is the latest thinking about diet and health. To give you a quick and easy guide, I distilled as much information as possible into the Healthy Eating Pyramid. But I also wanted you to see the blueprint -- the scientific evidence -- on which it is based. This is detailed in chapters 3 through 11. Along the way, I describe cutting-edge research that may radically change healthy eating patterns, including new information on the benefits of n-3 fatty acids found in some oils and nuts; on lycopene, a possible cancer-fighting substance found in tomatoes; on the potential hazards of getting too much calcium; and on why it makes sense to take a daily multivitamin.
This book also helps you incorporate this information into your snacks and meals with practical tips on buying healthy foods and eating defensively and a section that offers more than fifty tested, tasty recipes.
This information isn't meant to take the place of advice you get from your physician, especially if you have a medical condition that requires a specific diet. Instead I encourage you to talk about your diet with your health care provider or share what you've learned from this book with her or him to make sure you are on the same wavelength. Unfortunately, the pressures of modern medicine and health care often make it difficult for clinicians to spend time talking about healthy food choices with their patients.
Copyright © 2001 by the President and Fellows of Harvard College
Product details
- Publisher : Free Press; 1st edition (July 7, 2005)
- Language : English
- Paperback : 352 pages
- ISBN-10 : 0743266420
- ISBN-13 : 978-0743266420
- Item Weight : 10.5 ounces
- Dimensions : 5.5 x 0.9 x 8.44 inches
- Best Sellers Rank: #1,214,036 in Books (See Top 100 in Books)
- #5,161 in Nutrition (Books)
- #7,543 in Other Diet Books
- Customer Reviews:
About the authors
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Walter Willett,M.D., Dr. P.H., is Professor of Epidemiology and Nutrition and Chairman of the Department of Nutrition at Harvard School of Public Health and Professor of Medicine at Harvard Medical School. Dr. Willett, an American, was born in Hart, Michigan and grew up in Madison, Wisconsin, studied food science at Michigan State University, and graduated from the University of Michigan Medical School before obtaining a Doctorate in Public Health from Harvard School of Public Health. Dr. Willett has focused much of his work over the last 25 years on the development of methods, using both questionnaire and biochemical approaches, to study the effects of diet on the occurrence of major diseases. He has applied these methods starting in 1980 in the Nurses' Health Studies I and II and the Health Professionals Follow-up Study. Together, these cohorts that include nearly 300,000 men and women with repeated dietary assessments are providing the most detailed information on the long-term health consequences of food choices.
Dr. Willett has published over 1,500 articles, primarily on lifestyle risk factors for heart disease and cancer, and has written the textbook, Nutritional Epidemiology, published by Oxford University Press. He also has three books book for the general public, Eat, Drink and Be Healthy: The Harvard Medical School Guide to Healthy Eating, which has appeared on most major bestseller lists, Eat, Drink, and Weigh Less, co-authored with Mollie Katzen, and most recently, The Fertility Diet, co-authored with Jorge Chavarro and Pat Skerrett. Dr. Willett is the most cited nutritionist internationally, and is among the five most cited persons in all fields of clinical science. He is a member of the Institute of Medicine of the National Academy of Sciences and the recipient of many national and international awards for his research.
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Illustrative of the style and substance of the book, Dr. Willett writes: “[A] reason for writing this book was to challenge the misleading advice embodied in the U.S. Department of Agriculture’s [USDA’s] Food Guide Pyramid, which focused on avoiding all types of fat and loading up with starch… I sent the USDA a copy of the first edition of Eat, Drink, and Be Healthy and said it was welcome to use the evidence based Healthy Eating Pyramid my colleagues and I had developed, and which I had described in the book. As usual… though, politics and business trumped science—the USDA’s new MyPyramid offered even less guidance on healthy eating than its predecessor… in this edition I incorporate additional, important details that have emerged, including new information on weight-loss strategies; the benefits of specific fruits, vegetables, and vitamin D; the harms of trans fats; and other elements of healthy eating.”
Dr. Willett writes: “Over the past thirty-five years, my colleagues and I have been continually surprised by the impact of diet on the risks of a host of chronic diseases… information on medical history, smoking, physical activity, and other lifestyle variables would be needed to isolate the effects of diet… one of the most important conclusions of our work is that healthy diets—and there is no single healthy diet—do not mean deprivation or monotony…”
Dr. Willett writes: “Chapter One: Healthy Eating Matters… 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… 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….”
Dr. Willett writes: “[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… 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 protein, 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… 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”
Dr. Willett writes: “Using the blueprint laid out in the Harvard Healthy Eating Plate is a good way to improve your diet… how to put the omega-3 fats found in fish and some plants to work for you;… and why it makes sense to take a daily multivitamin… This book… ends with more than seventy tasty tested recipes… THROUGHOUT MOST OF HUMAN HISTORY, [most people] 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… What’s good for American farmers isn’t necessarily good for Americans’ health.”
Dr. Willett writes: “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… One strand of this evidence came from Greece. In the 1980s, Greek men lived four years longer than American men and had remarkably low rates of heart disease... Their diet was thought to have something to do with this… we created in 1993 a pyramid to represent the traditional Mediterranean diet… It was built on a base of healthy whole grains, fruits, vegetables, beans, and healthy fats. At the time it was widely criticized by many in the nutrition community because it was high in fat, mainly olive oil. Since then, various streams of evidence have confirmed that olive oil is a healthy source of calories… After an average of five years, those who had been following the Mediterranean diet had a 30 percent lower rate of cardiovascular disease compared with those in the low-fat group. Further analyses showed that those following the Mediterranean diet also had lower rates of diabetes and breast cancer...”
Dr. Willett writes: “The Harvard Healthy Eating Pyramid… based on solid science, offers better guidance for healthy eating than the advice from the USDA… Women and men with high… scores (those who followed the eating strategies embodied in the Healthy Eating Pyramid) had substantially lower risks of developing major chronic diseases, especially heart disease or stroke, than those scoring low on the index.”
Dr. Willett writes: “RESEARCH ABOUT DIET AND NUTRITION seems to contradict itself with aggravating regularity. You stop using butter and start spreading margarine on your toast, only to learn later that margarine can be as bad for you, and then later that butter isn’t as bad as it was once thought to be… This makes following health news seem like reading pages torn at random from a book or, worse, reading the pages with misprints… The amount and quality of sound scientific information on diet and health have grown enormously over the past thirty years… today’s recommendations will probably be subject to some fine-tuning, even though the big picture is unlikely to change appreciably… medical science has its own special rhythm, one that doesn’t fit with the media’s need to tell compelling but simple stories… Men and women carry out studies and report their results. Evidence accumulates… randomized trials are often impossible to do when it comes to nutrition… The Women’s Health Initiative—which tested the effect of reducing dietary fat to 20 percent of calories and increasing consumption of fruits and vegetables on the development of breast cancer, heart disease, and other chronic conditions among almost 60,000 women in the 1990s—cost more than $ 2 billion and didn’t yield clear answers on this important question, in part because there was actually very little difference in fat intake between women assigned to follow a low-fat diet and those following the comparison “usual diet.”
Randomized controlled trials are sometimes held up as the “best” evidence. But cohort studies can answer questions that aren’t possible in such trials, such as long-term effects of diet… Dozens of cohort studies of diet and health are in progress. They have already provided us with important information on connections between diet and disease, and will produce a flood of data over the coming years”
Dr. Willett writes: “Careful journalists try to put new research into perspective. But it’s impossible to cram that kind of context into thirty seconds of air time or 250 words, so you often end up with little more than… sound bites or headlines. [None-the-less, it is] worth paying attention to: Studies done on people… Studies done in the real world… Studies that look at diseases, not markers for them… Large studies… Weight of evidence. [And] This body of evidence points to a firm conclusion that drinking moderate amounts of alcohol reduces the risk of heart disease… Given the flood of information from nutrition research, I suggest that you not make big changes in what or how you eat based on a single study… In fact, Mark Twain’s… view of health information is [still good today] “Be careful about reading health books. You may die of a misprint.””
Dr. Willett writes: “Healthy Weight… If you are overweight, change your diet and exercise pattern so you won’t add any more pounds and ideally will lose some… data indicate that with increasing body mass index—a measure that includes both weight and height—the risks of heart disease, high blood pressure, gallstones, and type 2 diabetes all steadily increase, even among those in the healthy weight category. Above a body mass index of 30, which is the boundary between overweight and obesity, the risks continue to increase… Carrying too many pounds… has a direct effect on your current and future health… WHAT IS A HEALTHY WEIGHT?... [is] difficult to answer… A number called the body mass index (BMI)… [a] measure of weight adjusted for height does a good job of accounting for the fact that taller people tend to weigh more than shorter people… Setting guidelines for healthy BMIs has traditionally been done by examining death rates in large groups of people and then picking the BMIs with the lowest death rates as the “healthy range.” Most studies have shown that range to be BMIs between 18.5 and 24.9… Still, drawing the line at 25 means that two-thirds of adult Americans are overweight or obese… If your weight corresponds to a BMI above 25, you will do yourself a huge health favor by keeping it from increasing and, if possible, by trying to bring it down… In reality, adult weight gain is neither inevitable nor innocuous. In many cultures, gaining weight during adulthood just isn’t the norm… In a pooled analysis of cohort studies that included 650,000 men and women, a larger waist predicted a higher risk of premature death at every BMI… A waist size of 35 inches for women and 40 inches for men is a worrisome signal… WHY WE GAIN WEIGHT Your weight depends on a simple but easily unbalanced equation: weight change equals calories in minus calories out over time… Chalk up why you’re the weight you are to a combination of what and how much you eat, your genes, your lifestyle, and your culture… It’s likely that our prehistoric ancestors shaped our physiological and behavioral responses to food. Early humans routinely coped with feast-or-famine conditions… eating as much as possible whenever food was available might have been a key to surviving the lean times… The source of calories can influence how satisfied you feel after eating. Some foods, like an apple, can fill your stomach and leave you content for hours, while a can of soda with twice the calories will hardly ease your hunger… While carrying too many pounds is a key threat to health, it’s important not to lose sight of the fact that diet affects health in many ways that aren’t related to weight.”
Dr. Willett writes: “Most fad diets fail in the long run. For that matter, so do many middle-of-the-road, commonsense diets. The ultimate diet is one that offers meals and snacks that rapidly make you feel pleasantly full (technically called satiety)… LOW-FAT DIETS AREN’T THE ANSWER… A common though absolutely false thread that runs through many diets is the idea that fat in food makes fat in the body… there is no evidence that calories from fat contribute more to weight gain than calories from carbohydrates or other sources… Eating chicken, beef, fish, beans, and other high-protein foods that are the staples of low-carb diets slow the movement of food from the stomach to the small intestine. Slower stomach emptying means you feel full longer and it takes longer to get… hungry. Second, protein’s gentle, steady effect on blood sugar smooths out the blood sugar–insulin roller coaster caused by the digestion of rapidly digested carbohydrates like white bread, white rice, or a baked potato”
Dr. Willett writes: “There are better ways to cut back on unhealthy carbs. Eating more nuts, beans, soy foods, fish, poultry, nonstarchy fruits and vegetables, whole grains, and vegetable oils… can work for weight control even as it reduces the risks of heart disease, diabetes, and several cancers… LOW-GLYCEMIC DIETS MAY BE AN EXCELLENT OPTION… You don’t need to religiously follow glycemic index and glycemic load tables in planning meals or snacks. There are simpler rules of thumb: Don’t eat highly processed sources of carbohydrates such as breads, pastries, cereals, crackers, and other foods made with white flour; white rice; and sugar-sweetened beverages. Instead, eat more intact grains and foods made from them, in addition to fruits, vegetables, and beans… HEALTHY EATING… As I mentioned earlier, there’s a solid connection between healthy eating and weight loss.”
Dr. Willett writes: “The foods linked to greater weight gain included: • soda (overall, the most important food or beverage for weight gain because it was consumed so often) • potatoes in all forms • red meat… refined grains • sweets • fruit juice… Foods related to less weight gain included: • vegetables • fruits • whole grains • nuts • yogurt… GO MEDITERRANEAN The most impressive evidence for the benefit of a Mediterranean-type diet on long-term weight control comes from the Dietary Intervention Randomized Controlled Trial (DIRECT)… Among the participants who finished the two-year trial, those who followed the low-fat diet lost an average of 7 pounds, those following the Mediterranean diet lost about 10 pounds, and those on the low-carb diet lost 12 pounds… I recommend this three-pronged strategy: 1. If you aren’t physically active, get moving. If you are, try to be even more active. 2. Find an eating strategy that works for you. Those offered in this book are a great place to start. 3. Become a mindful and defensive eater… You need to find what works for you and stick with it… different strategies… 1. Get Moving… Exercise counts most toward good health… Build muscle, burn fat… The more muscle you have, the more calories you burn, even at rest. Without exercise, fat replaces muscle… It is easier to prevent weight gain than it is to lose weight… The two big questions about exercise are these: How much exercise do we need each day? And what is the best kind of exercise?”
Dr. Willett writes: “Walk for health… For many people, walking is an excellent type of physical activity because it doesn’t require any special equipment… there is a very strong link between walking and protection against heart disease… Exercise at least thirty minutes a day… Most recommendations translate this into time: thirty minutes of physical activity on most, if not all, days of… the week. There is no question that this much activity is far better than inactivity… thirty minutes of activity a day isn’t much… So consider thirty minutes of physical activity as a daily minimum for maintaining your health and weight… sitting isn’t good for the body.”
Dr. Willett writes: “Find a Diet that Works for You… A diet must work for you… individuals respond differently to weight-loss strategies… Diets low in refined carbohydrates often work best… Giving up refined carbohydrates in favor of whole grains, vegetables, fruits, and healthy sources of protein and fat… will reduce the spikes of glucose and insulin that provoke hunger… Not eating red and processed meats and eating in their place fish, nuts, beans, and poultry will reduce the risks for colon cancer, prostate cancer, premenopausal breast cancer, diabetes, and heart disease, even if the total amount of fat you are eating remains high. Choose a healthy global diet. An eating plan that borrows heavily from the Mediterranean and other traditional diets offers a healthy nutritional foundation.”
Dr. Willett writes: “[There was a] time when many experts believed that all fats were bad for the heart. This belief has faded in light of findings that unsaturated fats can improve cholesterol levels, reduce blood pressure, and snuff out potentially deadly heart rhythm disturbances… On average, most people do worse over the long run on low-fat diets than on higher-fat diets… Low-carb diets tend to be better than low-fat diets at helping people lose weight… Traditional Mediterranean diets have a relatively low impact on blood sugar because they use plenty of fruits and vegetables, are relatively high in healthy fats, and are relatively low in easily digested carbohydrates… The truth is, everyone, overweight or not, needs to watch what and how much they eat and to exercise… Two things we know for sure about weight-loss diets: • Almost any type of diet works for a while. • No single diet works for everyone… One of the main messages from the registry is that successful weight loss is very much a “do it your way” endeavor… Don’t get too discouraged or beat yourself up because a diet that “worked for everybody” didn’t pay off for you. Try another… A good diet… should be something you can sustain for years.”
Dr. Willett writes: “The war on dietary fat ignored the simple fact that your body needs fat… Some types are essential for you, and it’s important to include them in your diet. These are the healthy unsaturated fats found in plant oils like olive, canola, soybean, and corn oils, and in fish. Cutting them from your diet is a bad idea. The true bad fats are trans and saturated fats… Dietary fats aren’t the only factors that affect the risk of heart disease. Smoking, being overweight or obese, and inactivity contribute a substantial share of deaths and disability. But managing the type of fat you eat is an important way to prevent heart disease… SIMPLER GUIDELINES AREN’T ALWAYS BETTER… influential groups decided that Americans couldn’t grasp a concept as nuanced as good fat/ bad fat. Instead they settled on the simpler “Fat is bad” message. There’s no question that the public heard and heeded this message… But we’ve thrown out the baby with the bathwater, mainly cutting back on beneficial unsaturated fats.”
Dr. Willett writes: “REPLACING FATS WITH CARBOHYDRATES CREATES A NEW PROBLEM… Equally harmful, white bread and other foods made from white flour, potatoes, pasta, and white rice cause large spikes in blood sugar (glucose) and insulin, something that doesn’t happen with fat, protein, and slowly absorbed carbohydrates like those from intact whole grains, beans, fruits, and non-starchy vegetables...”
The author continues in this manner with information that is valuable to men and women both young and old.
What makes this book great is that its purpose is NOT to promote a diet- its purpose is to inform the reader about nutrition. Willet does not have an agenda- he's not trying to sell you on a diet, a line of supplements, snacks, or pills. He's not trying to get you to subscribe to a program. He's just trying to inform you about NUTRITION. In simple, easy to read language, he explains what happens inside of your body when you eat particular foods, and what the greater impact of that effect is in the long run. Generally speaking, the points that Willet makes are painfully obvious, once explained.
A perfect example of this is his clear explanation of how and why so many people with American, western pattern diets inflict diabetes upon themselves. I had always been told vague pieces of advice from well-meaning people who would say things like, "don't eat too much sugar, or you'll get diabetes" and "too much white bread/pasta/rice will give you diabetes". Unfortunately, nobody could tell me HOW or WHY this was the case. Willet explains, in very simple terms, how different foods are absorbed at varying rates of speed within our bodies... there is some slightly more advanced science behind this, but basically refined foods (like refined sugar and enriched flour) break down too quickly, and force our insulin production to spike. The more frequently this is done, the worse off your body will be, and it creates a vicious cycle of insulin spiking (not to mention the hunger and fatigue that result from eating refined foods). Thanks to Willet's clear explanations, I was finally able to understand what impact refined foods have on my body- and why I should stick to whole grains whenever possible.
Another fine example is how Willet points out that the Food Pyramid was created by the USDA, whose purpose is to protect the interests of American farmers... so why would you ever trust what they were telling you to eat?! Fortunately, the Food Pyramid has been done away with, but a lot of us grew up studying that cursed thing (I'm 32).
Finally, Willet puts into very clear terms that the single worst food you can ingest is refined sugar. Fat doesn't make you fat... SUGAR does! But wait, you say... what about sugar substitutes? Does Willet address those? Aren't they bad for you, too? Turns out they MIGHT be, but the existing body of evidence says no. Willet points out that nutritional science is always changing, because the research and data is ever growing- and he periodically revises his book to reflect that.
I keep this book close at hand, and use it as a reference. Whenever I'm wondering about a particular food, I look it up in the glossary and take a moment to educate myself. There is nothing more important to your health than the foods you eat, and as such, this book is an invaluable resource. I'm so glad I discovered it, and took the time to read it. It will positiviely affect my health and well being for the rest of my life :)
Top reviews from other countries
I actually bought the kindle version first and then got the physical book for the recipes.
Let’s explore the distinctive features and uniqueness of this groundbreaking work to understand and appreciate its contributions fully.
Challenging Conventional Misconceptions. Dr. Willett adeptly dismantles prevailing dietary dogmas, particularly critiquing the USDA’s food pyramid that once dominated nutritional guidance. By dissecting the flawed emphasis on certain food groups without adequate consideration for quality and source, the book clears the confusion surrounding dietary fats, protein, and carbohydrates. For example, he scrutinizes common misconceptions, such as the overemphasis on carbohydrate consumption and the demonization of all fats, presenting a nuanced view of dietary fats and their impact on health.
Thought-Provoking Questions and Insights. The book excels in posing thought-provoking questions that encourage readers to critically assess their dietary habits and explore the rationale behind common dietary guidelines, thereby fostering a more informed and reflective approach to nutrition. Dr. Willett’s insights on the complex relationship between diet and chronic diseases, such as diabetes and heart disease, illuminate the profound impact of dietary choices on long-term health.
Authoritative and Science-Based Source. As a leading figure in nutritional epidemiology, Dr. Willett brings unparalleled expertise to the discussion. His authoritative voice, backed by decades of research at the Harvard School of Public Health, ensures that readers are receiving advice from one of the most credible sources in the field. The 2017 update integrates the state of the science up to that point, providing readers with new scientific findings and information.
Objective and Academic. One of the book’s strengths is its objectivity. Dr. Willett’s approach is devoid of hidden agendas or political bias, focusing solely on presenting academic, evidence-based information. This academic rigor makes the book a trustworthy resource for individuals looking to understand the why and how behind healthy eating, enabling them to make informed decisions about their health based on the latest scientific evidence.
Fully Informative with Clear Explanations. Not content with merely dictating what to eat or avoid, “Eat, Drink, and Be Healthy” excels in offering clear, thorough explanations about the mechanisms by which different foods and nutrients impact health. This level of detail empowers readers with a deeper understanding of nutrition’s complexities, moving beyond superficial dietary do’s and don’ts. This comprehensive approach demystifies nutritional science, making it accessible to the lay reader.
Practical Guidance. Beyond its academic rigor, the book stands out for its practicality. Dr. Willett provides actionable guidelines that readers can seamlessly integrate into their daily lives, making healthy eating an attainable goal rather than a tough challenge. This practical advice, from simple dietary adjustments to recommendations for meal planning, is tailored to fit the diverse needs and circumstances of the book’s audience.
Well-Structured and Accessible. With its well-structured content and easy-to-follow format, this book is both a joy to read and easy to implement. Its reader-friendly approach makes complex concepts understandable to a broad audience, from health professionals to individuals seeking to improve their dietary habits.
While “Eat, Drink, and Be Healthy” stands as a pillar of nutritional guidance, the evolving and dynamic nature of scientific research means that new findings continue to emerge. Readers may anticipate future versions of the book that include the latest developments, such as the debates on vegetable oils, saturated fats, and multivitamin supplements, further refining our understanding of healthy eating.
“Eat, Drink, and Be Healthy” is rightfully heralded as a bible for healthy eating. It is a must-read that deserves a place on every health-conscious individual’s bookshelf, promising not just a guide to healthy eating but a foundation for a healthier life.
Anyone interested in nutrition or trying to change his/her eating habits should read it!