19. Nutrition and Stress

In this chapter you will learn to:

• Assess your current eating habits
• Eat a balanced diet to optimize health and manage stress
• Eat to prevent or minimize chronic disease

Background

Eating is one of the natural joys in life, as well as a wonderful strategy you can use to reduce stress. Preparing and eating well-balanced meals is a delightful way to give yourself pleasure as well as providing good care of your body. Meals can be a time to relax and socialize and, as such, they help to reduce stress. Most cultures celebrate holidays and the passages of life with feasting; these times bring people together and give life meaning. Unfortunately, the foods that people eat for pleasure are not always nutritionally sound. Eating right is a learned skill and not something that “just comes naturally.”

The American retail food industry actively promotes convenience and fast foods over fresh foods. Grocery stores now stock four times more convenience foods than they do produce and other fresh foods. People with face-paced, busy lives embrace these convenience foods. However, in so doing they lose out on good nutrition, creativity, and the sense of accomplishment that comes with planning, preparing, and eating their own meals—all activities that help to decrease stress.

America’s love affair with snack foods has led some people to joke that the four major food groups are candy, cookies, coke, and chips, but the result of Americans’ supersized portions of these foods is not a laughing matter. The average American diet, with its emphasis on large portions and convenience foods, contains too much fat, sugar, and sodium. Adult obesity rates have increased from 15 percent of the total population in 1980 to 33 percent in 2005. Obesity now exceeds 20 percent in all but four states, and has reached epidemic levels (CDC 2005). But obesity is only one of the risks run by physically inactive people who eat a high-fat, high-calorie diet. It is well-known that such a diet contributes to the nation’s high rates of degenerative joint disease, high blood pressure, cardiovascular disease, and some cancers.

This chapter will help you assess your present eating habits and provide you with guidelines for a healthy diet. You can compare your current diet with these recommendations and set goals for retraining your eating habits. By taking charge of your nutritional health, you will begin to enjoy healthy eating. You’ll find that it isn’t hard to eat a balanced diet, even if you’re not a chef at heart.

Symptom-Relief Effectiveness

A healthy body responds to the inevitable stresses of life better than an unhealthy one, and good nutrition is an essential building block of good health. Eating well can help prevent or control high blood pressure, heart disease, indigestion, constipation, hypoglycemia, diabetes, and obesity. Good eating habits may also reduce irritability, PMS, headaches, and fatigue.

Time to Master

Plan to keep track of your food intake for three days. After reading the guidelines for a healthy diet, you will go on to compare them with your own eating habits and then decide what changes you want to make in your diet. You can begin to apply the recommendations in this chapter in a matter of hours. To make lasting changes in your diet, plan on gradually introducing a few changes at a time that you can stick with for a minimum of one month.

Twelve Steps to Positive Eating

These twelve steps to positive eating will help you feel better today and stay healthy for tomorrow. They include the basics of the Dietary Guidelines for Americans (2005). The Guidelines provide authoritative advice for people two years and older about how good dietary habits can promote health and reduce risk for major chronic diseases. They serve as the basis for federal food and nutrition education programs. They offer tips on healthful food preparation and making healthy eating a habit.

The 2005 Dietary Guidelines provide suggestions on how to eat to feel better today and to stay healthy for tomorrow. (See website in the Websites section at the end of the chapter.) The five Feel Better Today steps that follow are for actions that produce immediate results. They include making smart choices from all food groups; maximizing nutrition in your calories; eating frequent, calm meals; planning ahead; and finding the right balance between food and physical activity. Our seven Stay Healthy for Tomorrow steps have longer-term effects and suggest changes that impact your health over the long term. Staying healthy may depend on cutting back fats, limiting sodium, attaining your ideal weight, limiting caffeine and alcohol, and taking vitamins.

MyPyramid reinforces the concepts of good eating practices. MyPyramid Food Plans provide personalized food plans. This sample plan on the next page is for Sharon, a 5'7", forty-year-old paralegal who is moderately active and weighs 170 pounds.

MyPyramid provides nutritional guidelines, which now include exercise guidelines. The slices of the pyramid represent the various food groups and provide guidance on a balanced diet.

Feel Better Today: Make Smart Food Choices by Eating a Variety of Foods

You need over forty nutrients for optimum health. These are classified as macronutrients (proteins, carbohydrates, and fats) and micronutrients (vitamins and minerals). (As the names suggest, you need the former in larger quantities and the latter in smaller amounts.) Although an excess of macronutrients will lead to weight gain, an excess of micronutrients may actually be toxic for you, or at the least a waste of the money spent on unnecessary vitamin or mineral supplements.

There is no perfect food. Even milk, which provides the cornerstone of a baby’s diet, doesn’t supply vitamin C or iron, which is why we include juice and cereal among baby’s first foods. Even the natural foods favored by many health-conscious individuals can contain naturally toxic components. For instance, potatoes naturally contain over 150 chemicals, including traces of arsenic and solanine—chemicals that are safe in low doses but poisonous at high ones (according to www.acsh.org/news/newsID.184/news_detail.asp). Varying your diet helps to maximize your nutrients and minimize your exposure to any toxic substance or contaminant. A wide variety of foods supplies a wide variety of nutrients.

When you visit the MyPyramid website (www.mypyramid.gov), you can obtain a personalized eating plan to maintain your weight or reach a healthier weight. The following practices are recommended for an average diet of 2000 calories a day:

• Make half your grains whole. Eat six servings of grains daily, including bread, rice, cereal, and pasta products, the proverbial “staff of life.” At least three of these choices should be whole grains, such as whole grain breads or pasta, to add fiber to your diet. Enriched grain products restore the known nutrients that may be removed by milling. When you do buy refined foods, be sure they are enriched to restore the B vitamins and iron lost in milling. Six servings may seem like a lot, but it really isn’t. Many people eat two servings of cereal at breakfast. A sandwich provides two more servings of bread, and a plate of spaghetti easily provides two more servings of pasta of a half a cup each.
• Vary your veggies. Your veggies should total 2½ cups daily. Be sure to select vegetables of different colors to obtain all the nutrients and antioxidants required for optimum health. It is recommended to eat at least 3 cups of dark green veggies, 2 cups of orange veggies, and 3 cups of starchy veggies weekly.
• Focus on fruits. Eat fresh fruits rather than drinking fruit juice. Try for a total of 2 cups daily; for example, 1 small banana, 1 large orange, and 6 to 8 dried apricot halves. Dried fruit makes an easy, nutritious snack; just remember the same weight of that dried fruit has the same calories as the fruit had before it was dried, so if you would eat one fresh pear, eat no more than two dried pear halves.
• Concentrate on calcium-rich foods. Take the equivalent of 3 cups of low-fat or fat-free milk every day. Substitute 1 ounce of cheese or ½ cup cottage cheese or 1 cup yogurt for 1 glass of milk.
• Go lean with protein. Consume 5.5 ounces of protein daily. Read labels and choose meat items that have less than 3 grams of fat per serving. Using beans and legumes liberally in your diet will help keep your protein intake up and your fat content down. A ½ cup of beans, lentils, or soy products is the equivalent of 1 ounce of meat. Choose fish for the omega-3 fatty acids that help to control your LDL cholesterol. Be aware that some fish have more fat than lean red meat, and that red meat contains the iron that most women need. Bake, broil, or barbecue to reduce fat. Remove the skin from chicken before cooking, since just the skin on one chicken breast has 5 grams of fat.
• Oils and fats. These should be poly- or monounsaturated. Aim for a maximum of 6 teaspoons of monounsaturated oils and fats daily. Monounsaturated oils include olive oil and canola oil.
• Discretionary calories. These are your luxury food choices that add fat and sugar. You will have about 250 daily calories for fun foods of your choice. How about an oatmeal cookie or two?

Eating grains, fruits, and veggies that provide starch add to your sense of well-being. You’ll notice that complex carbohydrates and fiber make meals more filling and satisfying. Eating lots of fresh fruits and vegetables is also good for your peace of mind, since these “power foods” contain the fiber, vitamins, minerals, and phytonutrients (natural plant chemicals) that can protect you against chronic illnesses, including diabetes, cancer, and heart disease. Carbohydrates also seem to function as “edible tranquilizers.” They contain tryptophan, an amino acid that stimulates the production of serotonin in the brain. Serotonin has a calming effect that eases tension and may cause drowsiness. Is this the explanation for that happy full feeling that a big spaghetti dinner usually seems to create?

Evidence continues to build that dietary fiber (including cellulose, gums, pectin, and lignin) is an essential component of a healthy diet. Fiber helps to prevent or reduce constipation by increasing stool bulk and water absorption to control blood sugar and blood lipids by binding nutrients. It also decreases stool transit time, thus reducing the risk of colon cancer and diverticulitis.

Although the recommended intake of dietary fiber is 25 to 40 grams daily, the average American consumes only 5 to 10 grams. For most of us, fresh fruits and vegetables, whole grains, and legumes are the chief sources of fiber in our diets. You can supplement your fiber intake by increasing your use of legumes and bran products or by adding bran to homemade foods. Plan to increase your fiber intake gradually, as rapid increases can lead to bloating and flatulence.

Feel Better Today: Eat Frequent, Calm Meals

Positive eating includes taking the time to prepare and eat frequent meals or snacks and relaxing while we eat them. Our fast-paced society, along with a plethora of fast-food options, encourages eating on the run and denies us the time to relax while we eat. Our bodies run better if we refuel them frequently. Blood sugar is like gasoline for a car, and we all know a car won’t run if its fuel tank is empty. Eating three to five small meals a day helps to maintain an even blood-sugar level.

To reduce the daily stress of meal preparation, plan meals and shop weekly. When you cook, prepare enough for additional meals or snacks. It’s cheaper, quicker, easier, and healthier to reheat something in the microwave than to run out to buy a fast-food meal. Also, reheated leftovers make tasty lunches to take to work.

At work, take time away from your workstation to sit and relax with your meal or snack. Likewise, take some time alone to relax and reflect during your breaks. Learn to savor the flavors, textures, and colors of your food.

Feel Better Today: Don’t Give In to Temptation When You Eat Out or Are on the Go

It’s important to have a basic food plan and to make smart choices at the grocery store, at work, at restaurants, and when you are on the go running errands or chauffeuring the children.

• Make a weekly menu and grocery list to save time and ensure that you have the ingredients for simple meals in your cupboard and refrigerator.
• Avoid the convenience foods and impulse items at the ends of the supermarket aisles. For lunch at work, take some healthy leftovers or make a sandwich on whole wheat bread. Drink a sugar-free beverage or a serving of low-fat milk and take a piece of fruit for dessert. This is cheaper and healthier than eating at the deli.
• When running errands, chauffeuring, or commuting, take along some sliced-up fruit, baby carrots, string cheese, or raw almonds.

Feel Better Today: Balance Food and Activity

About one-third of the new MyPyramid is comprised of steps representing the importance of physical activity in our lives. Every day that you eat, you should plan to get some form of exercise. Sixty minutes of moderate intensity exercise is recommended for most days. Our bodies were made to move, and we feel better if we are more active. Find a friend or get a dog to walk with. A dog will get you into the habit of a daily walk and won’t let you miss a day. Vary your activities so that you won’t become bored with your exercise routine. You’ll be surprised when you begin looking forward to your exercise time. If finding time to exercise is a problem, take the stairs at work and park a few blocks away from your workplace. See chapter 20, Exercise, in this workbook for more ideas on this important topic.

The MyPyramid Food Calorie Levels are based on your activity level. Sedentary is defined as less than thirty minutes of moderate physical exercise in addition to your daily activities. Moderately active is thirty to sixty minutes of daily exercise and Active is defined as more than sixty minutes of daily exercise in addition to your daily routines.

Determine your activity level, then select your gender and age to find your recommended calorie level. The numbers that appear under your activity level and across from your age are the recommended daily amounts of calories you should consume for optimal health. After you determine your calorie level, check the MyPyramid Food Intake Patterns chart and note your daily number of food choices from each group. When you’ve completed these steps, you’ll have the information you’ll need to evaluate your dietary intake according to your activity level.

USDA Center for Nutrition Policy and Promotion, April 2005

Feel Better Today: Maximize the Nutrition in Your Calories

You have just determined your personalized calorie allowance and recommended servings from each food group. It’s important to choose a wide variety of nutritionally rich foods each day; foods that are packed with vitamins, minerals, fiber, and other micronutrients. Pick fresh fruits, whole grains, and low-fat dairy products. Look at nutrition labels to make your calories count. Any food item with over 400 calories per serving is too high in calories.

Sugars contribute many calories and few, if any, nutrients to your diet, so use foods low in added sugars. Sugars include sucrose, glucose, fructose, high-fructose corn syrup, corn syrup, honey, and maple syrup. Americans have a sweet tooth. If you’ve been abroad, you’ve probably noticed that American desserts tend to be much sweeter than desserts from other parts of the world. Including table sugar, sugar in soft drinks, canned foods, baked goods, and other sweets, the average American eats 130 pounds of sugar and sweeteners annually. These items provide very few nutrients.

As children, we were given sweets to comfort us. So as adults, when we are stressed, we still reach for cookies, candy, or sweets. Women are more likely to seek solace in sweets than men. It is thought that sweets trigger the release of endorphins, the natural opiates that create euphoric feelings. Although sugar may provide a temporary “high,” it also stimulates the pancreas to secrete insulin to process the sugar. The pancreas sometimes overreacts and secretes excess insulin. The result can be hypoglycemia, a condition characterized by dizziness, irritability, nausea, and hunger pangs that may, in turn, prompt a craving for another sweet treat. Cravings for sweets are better satisfied with a piece of fruit. Fruit provides the complex sugars, fiber, and vitamins that sugary foods lack.

Clues for cutting sugar:

• Use less sugar, raw sugar, honey, and corn or maple syrup.
• Eat fewer foods that contain sugar, such as candy, cookies, and soft drinks.
• Select fresh fruit or fruits canned in juice or light syrup rather than heavy syrup.
• Avoid foods with sucrose, glucose, maltose, dextrose, lactose, or fructose listed as first ingredients.

Stay Healthy for Tomorrow: Cut Back on Fats

Despite all the bad press that fat has received in recent years, the average American ingests significantly more of his or her calories from fat (37 to 42 percent) than the 20 to 30 percent or less recommended by the U.S. Dietary Guidelines. We talk about cutting fat, but when we get hungry we still reach for our high-fat favorites, despite the presence of so many alternatives. The food industry has come up with dozens of new lower-fat snack and cookie products to help you make the change, but fruit or vegetable sticks are still the best low-fat snacks. Any bookstore has shelves full of low-fat cookbooks that offer menus full of tasty and creative dishes. Fat-free salad dressings or flavored vinegars provide alternative ways to reduce the fat in your diet. Even those people with no time to cook can fall back on “lean” or “healthy” frozen entree products. Be sure to check the label and select items with 3 grams or fewer of fat per serving.

There are three kinds of fat. Saturated fat is solid at room temperature and is usually of animal origin. Examples are visible meat fat, chicken skin, and butter. Crisco is an example of a trans fat, or an oil that has been highly saturated, or hydrogenated. U.S. Dietary Guidelines suggest keeping saturated fats under 10 percent of daily caloric intake and trans fats as low as possible. Polyunsaturated fats, like corn and safflower oil, remain liquid even when refrigerated. Unsaturated or monounsaturated fat is liquid at room temperature but solidifies when chilled. Monounsaturated oils, such as canola and olive oil, are now recommended over polyunsaturated oils. Although the exact relation of fats to hypertension and heart disease is still controversial, the most widely accepted theory is that saturated and trans fats contribute to heart disease and strokes by elevating the body’s cholesterol level. The Dietary Guidelines (2005) recommend total fat intake of 20 to 35 percent of total calories, or 400 to 700 fat and oil calories daily in a 2000 calorie diet.

Dietary products to reduce or modify fat intake are widely available on the market, but there are as yet no long-term studies of their impact on health. Molly McButter is a low-calorie butter substitute. Products containing omega-3 fats are available to assist in reducing triglyceride and cholesterol levels. Fat replacers like olestra (brand name Olean) are chemically altered so that they pass through the body unabsorbed.

Plant Stanols and Sterols

Plant stanols and sterols are found in cholesterol-lowering spreads. Plant sterols and stanols are phytosterols—essential parts of plant membranes that resemble the chemical structure of animal cholesterol and carry out similar cellular functions in plants. Sterols are present in small quantities in many fruits, vegetables, nuts, seeds, cereals, legumes, vegetable oils, and other plant sources. Stanols occur in even smaller quantities in many of the same sources. Benecol, a brand with stanol esters, can be used both as a spread and for cooking; whereas Take Control, a brand with plant sterols, is recommended for use only as a spread but not recommended for cooking.

How do you score on fat intake? Answer the following questions by circling the number in the column that best describes how often you select or limit the foods listed on the scorecard. Add up the numbers you circled for your total score.

Insert Your Fat Score:_____________________

Scoring. If you scored 10 to 59 points, you can do better. At 60 to 79 points, you’re on your way. If you scored over 80 points, keep up the good work!

Stay Healthy for Tomorrow: Limit Sodium Intake and Increase Your Potassium Intake

Although sodium is an essential mineral, most adults in the United States ingest more than the recommended sodium requirement. The Dietary Reference Intake for recommended daily sodium intake is 1300 to 1500 milligrams (mg) for adults or approximately less than one teaspoon of salt a day. One teaspoon of salt contains 2300 mg of sodium. Generally, adult men average more salt than 4200 mg daily and women average 3300 mg daily (DRI). Sodium regulates body fluids, maintains pH balance, and controls nerve and muscle activities.

Our major sodium sources are table salt (composed of 40 percent sodium and 60 percent chloride) and processed foods, but sodium is also a natural component of milk, cheese, meats, and bread. A single slice of bread contains the minimum daily requirement for salt (230 mg of sodium). Check the label, and if any food serving has more than 500 mg of sodium, the salt content is too high, providing more than 20 percent of your daily total. If hypertension runs in your family, you may want to restrict sodium with the DASH (Dietary Approaches to Stop Hypertension) plan of eating. Information about this plan is available on the Internet or at your bookstore.

A high intake of sodium correlates with high blood pressure and increased risk of stroke. Since stress also aggravates these conditions, you will be wise to reduce your salt intake. Salt also increases edema, an excess accumulation of fluid that adds to the stress of premenstrual syndrome. High potassium intake (lots of fruits and vegetables) counteracts some of the effects of sodium on blood pressure.

Tips for shaking the salt habit:

• Avoid salty snacks like chips, pretzels, and nuts.
• Limit your intake of salty condiments like soy sauce, pickles, and cheese.
• Restrict your use of cured meats, sausages, and bacon.
• Learn to savor food with less salt and to substitute spices and herbs.
• Do not cook with salt and add little or no salt at the table.
• Read labels carefully. Avoid foods with salt or sodium listed in the first three to four ingredients.

Stay Healthy for Tomorrow: Know Your Ideal Weight and Body Mass Index

The body mass index (BMI) is one frequently used technique to assess body weight. BMI is a number based on a weight-height ratio that indicates your weight-related health risks. It doesn’t measure body fat, nor does it take gender or age into consideration. A BMI of 18.5 to 24.9 indicates a low risk for weight-related problems. A BMI of 25 to 29.9 indicates some risk for weight-related health problems, and a BMI over 30 indicates a significant risk for weight-related health problems. Look at the BMI Table and determine your BMI and health-risk level. Another way to assess your health risk is waist measurement. If your BMI indicates a health risk and your waist is over 35 inches for women or more than 40 inches for men, your health risks increase as your waist size increases. This is based on research that indicates those with “apple-shaped” bodies have more health risk factors than those with “pear-shaped” bodies, who carry their weight on their hips and thighs.

Healthy Weights for Men and Women

Stay Healthy for Tomorrow: Attain or Maintain Your Ideal Weight

Although there are thousands of weight-reduction diets, the best weight-control strategy is a lifelong sensible eating plan. Today, we know that diets just don’t work. Current research indicates that “yo-yo” dieting damages health and makes each successive attempt to lose weight even harder.

Diets don’t work because most dieters don’t reach their diet objectives. After all, diets represent food deprivation, which is emotionally difficult for most of us. In addition, your body interprets the diet regime as a famine, and reduces your overall metabolic rate to decrease the impact of deprivation on your body. The more rigorous the diet, the more your body will resist losing weight. For those who do achieve significant weight loss, more than 95 percent of them will not keep the weight off for even one year, and they end up dieting again. This sets the yo-yo spinning, and with each new diet the body lowers the energy required for maintenance a little bit more, making weight control increasingly more difficult.

It is better for you to maintain a moderate weight gain than to diet continually in order to lose the same ten pounds over and over again. The simple math is that you must expend more calories than you eat in order to avoid gaining weight. The ideal combination is to eat a little less and exercise a little more. It is also possible to eat the same quantity of food, or even more, if you cut the fat content of your food.

The best approach to weight control is to reduce your daily food intake by 100 calories and to burn 100 more calories a day by increasing your exercise. This means that by cutting out one slice of bread a day and walking one mile a day more than you do now, you will be twenty pounds lighter one year from now!

Diets are just a temporary quick fix; weight control is a lifelong lifestyle issue. Dealing with this issue means making a commitment to low-fat cooking methods, to choosing low-calorie, low-fat foods consistently, and to being satisfied with smaller portions.

A program that provides good nutrition education and realistic exercise goals can help you make a lifelong commitment. For example, Weight Watchers, one of the most reputable programs, advocates eating lots of vegetables, cutting down on fat, and increasing exercise. It also offers behavior modification programs, and support. There are chapters in most cities; check your phone book or local website for a convenient location. Other organizations that provide educational and support programs include Overeaters Anonymous, the YMCA and YWCA, as well as many health-insurance programs, local colleges, and community centers.

Good weight-control programs emphasize behavioral changes that enhance weight control, such as the following:

• Eat slowly. Take small bites and truly enjoy the color, taste, and texture of your food. After you’ve finished eating a meal, remember that it takes twenty minutes for the hypothalamus—the area in the brain that governs appetite and hunger—to register that you are full and to provide that feedback that you are full to your brain.
• Concentrate on eating. Eat mindfully. Don’t read or watch TV while eating. Enjoy eating as your primary activity so you can be aware of flavors, colors, and portion size.
• Eat regularly. Some studies have shown that people who eat three to five small meals daily are more likely to control their appetite and their weight successfully. This may be because they do not get excessively hungry and overeat. People who eat breakfast consume fewer calories, maintain healthier weights, and have reduced risk of heart disease. Studies also indicate that people who eat a healthy breakfast consume fewer total calories daily (Duyff 2006).
• Control portion size. Portions are generally a half a cup. You can eat anything you want so long as the portion fits in a four-ounce Pyrex custard cup.
• Don’t eat when you’re bored. Substitute a different pleasurable activity, such as taking a walk, calling a friend, or engaging in a hobby.
• Don’t eat when you’re angry. Write a letter to the person you’re angry with (but don’t send it) or go jogging or do some gardening. If you must bite down on something, make sure that something is a carrot or sugarless gum.
• Don’t eat when you’re tired. Go to bed or take a hot bath. You may be surprised to find that a walk or a bike ride may even reenergize you.
• Don’t eat when you’re anxious or depressed. Engage in physical activity, go to a movie, talk to a friend, or find a way to deal with the issues contributing to the anxiety or depression.

Stay Healthy for Tomorrow: Limit or Avoid Caffeine

Coffee, tea, chocolate, colas, and some medications may be high in caffeine, which may contribute to irritability, nervousness, sleep difficulties, and gastrointestinal distress. If you drink regular coffee, that is, not decaffeinated, a daily limit of 200 mg of caffeine, or 1 to 2 cups of percolated coffee, is recommended by the American Medical Association.

Stay Healthy for Tomorrow: Drink in Moderation or Not at All

As a tool for reducing stress, alcohol has the bothersome side effect of reducing one’s accurate perceptions of reality as well. Although some research indicates that a drink a day may increase longevity, reliance on alcohol to deal with daily life is a dangerous practice. Alcoholic beverages are high in calories and low in nutrients. Excess alcohol depletes B vitamins, alters blood sugar, elevates blood pressure, and disrupts relationships. If you drink, limit yourself to one to two drinks.

Stay Healthy for Tomorrow: Take a Multivitamin Tablet Daily

In the early 1990s, the Food and Nutrition Board of the National Academy of Sciences undertook the task of revising the Recommended Dietary Allowances (RDAs), and the Dietary Reference Intakes (DRIs) were born. DRIs include the Recommended Dietary Allowance (RDA), the Adequate Intake (AI), and the Tolerable Upper Intake Level (UL). The old Recommended Dietary Allowances (RDAs) are now expressed as Dietary Reference Intakes (DRIs). DRIs are daily nutrient recommendations based on age and gender and are set at levels to meet the needs of healthy individuals. The recommendations include allowances for individual variation. You will also see Daily Values (DV) used on vitamin and nutrition labels, which are based on the RDA.

Vitamins and minerals are necessary in small amounts, and without them metabolism is impaired. Because we do not all eat according to the recommendations every day, a multivitamin tablet may serve as an “insurance policy.” However, taking vitamins is not a substitute for eating well. There are undoubtedly compounds in foods that we have not yet identified that are nutritionally important adjuncts to the proper functioning of vitamins and minerals in metabolism.

Multivitamins provide you with extra amounts of the B vitamins, which are linked to stress, and vitamins A, E, and C, which seem to have anticarcinogenic properties. Multivitamins can also supplement any minerals that have been inactivated by fiber in the diet. Vitamins marketed as “stress tabs” or “stress formulations” are meant to be taken for physical stress, rather than psychological stress. Note that more is not better when supplementing vitamins and minerals.

Fat-soluble vitamins may become toxic because they accumulate in the liver. New evidence indicates that an overdose of water-soluble vitamins may also be toxic. We do know that consistent doses of over 3 grams of vitamin C a day increase the risk of kidney stones. Vitamin and mineral function is interrelated: vitamin C enhances iron absorption; vitamin D, calcium, and phosphorus work together in bone metabolism; and B vitamins are necessary for burning glucose as a fuel for the body. As stated, vitamins and minerals are interrelated, so increasing intake of one often causes an imbalance in another. Supplements should not exceed the Tolerable Upper Intake Level (UL) for each element, due to the danger of toxicity.

Bold type = RDA, regular type = AI (National Academy of Sciences 2004)

Self-Assessment

Daily Food Diary

If you are interested in making significant changes in your eating habits, it will be worth your while to keep a record of everything you eat and drink for the next three days. Be sure to note the sizes of the portions. By doing this, you will discover exactly how much you neglect certain food groups and overindulge in others. You will be amazed to see how sugars and fats sneak into your diet. You will see important connections between the circumstances in which you eat and drink, your feelings, and your diet. You can compare your food diary records with the guidelines in this chapter to create a plan for a more nutritionally balanced diet. You may want to repeat this exercise periodically to measure your progress.

Before you start, take a look at Sharon’s sample diary. Notice that in addition to writing down everything that she ate, she also noted the setting in which she ate and how she felt while she was eating. You should do the same as you record your daily intake.

Refer to Sharon’s diary and MyPyramid Plan to fill in the Food Group Servings column of your diary. Sharon’s example shows you how to count servings. Here are some specific guidelines to keep in mind:

• Note that low-fat milk counts as one milk serving and one fat serving, because nonfat milk is the recommended milk serving. Use plain or light yogurt to avoid the sugar content of yogurt with added fruit.
• Count all alcohol, cookies, cake, donuts, ice cream, or sweet rolls as discretionary and record their calories. All treats with fat or added sugar count in the discretionary group.
• Note that French fries contain at least three teaspoons of oil (equal to three servings of fat).
• Salad dressing is one fat serving for every 1 to 2 tablespoons of dressing. Use olive oil and vinegar for a healthy dressing.

Now, make some extra copies of the blank Daily Food Diary form and use them to record your food intake for at least three days. Be sure to write down where and when you eat, the setting and the people with you at the time, and your feelings. Eating is often tied to internal and external cues, and keeping track of this information may give you clues as to why you eat the way you do.

Summarizing Your Food Diary

For each day that you kept your Daily Food Diary, add up the total number of servings in each food group and write that number in the appropriate box on your Food Diary Summary. Average the result for each food group for the three days. Write this number in the Daily Average column for each food group. You will then be able to compare your daily averages for each food group with the ideal servings listed in the sixth column of the summary form. Refer to Sharon’s Food Diary Summary as an example and then go on to fill out the blank Food Diary Summary using the personal data in your Daily Food Diary forms.

Taking Charge of Your Nutritional Well-Being

The food guide pyramid provides a goal for daily food choices. Review your Food Diary Summary and compare your average servings per food group against the ideal servings. Put a check in the margin of the groups in which you were below the recommendation. Put a star in the margin next to the groups in which you exceeded the recommendation.

After reviewing the facts presented in this chapter, is your diet more like the typical American diet or the MyPyramid recommendations? Chances are good that your diet is generous in fats and sugars and skimpy on fruits, vegetables, grains, bread, and cereals.

After Sharon had reviewed her own summary, she sat down and filled out her goal-setting chart. The solutions she developed may suggest some positive steps that you can take.

Now it’s time to fill in your own positive eating goals below. After completing your goals, go back to your Daily Food Diary again and review the settings in which you ate. Note anything about the settings in which you ate that might contribute to unhealthy eating behavior. For example, it’s clear from Sharon’s sample diary that eating alone at her desk provided no break from work and may have made her less efficient as her tension level grew in the afternoon.

Having lunch with friends or, at least, in a different locale would have provided a change of scene. She takes her breaks in the coffee room, where high-fat, high-sugar snacks are a constant temptation. If she plans ahead and takes a piece of fruit or some light yogurt to the coffee room, she can still have the benefits of socializing, and will markedly improve the nutritional value of her break.

Set Your Personal Positive Eating Goals Now

What changes or improvements would you make regarding the setting in which you eat?

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Now review the feelings that you recorded in your Daily Food Diary. Note any feelings that contributed to unhealthy eating behavior. For instance, looking at Sharon’s food diary, you can see that she uses comfort food to try to feel better when she has negative feelings and sensations (tension, headaches, boredom, fatigue). Aerobic exercise, socializing, or a relaxation exercise might have been more effective for symptom reduction. She can also plan ahead to have a favorite low-calorie substitute available for those times when she knows she is likely to feel down. Going to bed earlier might prevent her need to snack when she feels bored or tired at night. If an earlier bedtime led to getting up earlier in the morning, she would also have time for a less hurried breakfast. How do your feelings contribute to your dietary intake? What changes can you make?

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Changing your eating habits will take some time. Concentrate on no more than one to two goals at a time for a minimum of one month. When you have integrated these new eating habits into your daily life, set one to two more goals. Depending on how many habits you wish to change, you should be enjoying a healthier lifestyle in one to six months. Making too many changes at a time can be stressful, so ensure your success by going slowly. Note that the changes you make to your diet also need to be tasty ones, otherwise you will feel deprived and have difficulty sticking with your plan.

Final Thoughts

You have the power to take charge of your eating habits, and taking charge will make a positive difference. Just keep the twelve steps of positive eating in mind and gradually make changes in your food selections. Put a copy of MyPyramid on the refrigerator as a reminder and keep it in mind when you shop. Go to your local bookstore and check the cookbook section for a new low-fat cookbook or magazine to inspire you. If you need a personalized nutrition plan, consult a registered dietitian at your medical clinic or check the yellow pages of the phone book. If you have questions about nutrition, try the American Dietetic Association website. Food is a necessity and a pleasure in life, so make positive, healthy choices!

Further Reading

Cain, A. A. 2006. Cooking Light Cookbook. Birmingham, AL: Oxmoor House Inc., Subsidiary of Southern Progress Corp.

Centers for Disease Control (CDC). 2005. Behavioral Risk Factor Surveillance System. www.cdc.gov/brfss

The Copenhagen Heart Study. 2000. European Heart Journal 24:567–576.

Dietary Guidelines for Americans. 2005. Published jointly by the Department of Health and Human Services (HHS) and the Department of Agriculture (USDA).

Duyff, R. 2006. The American Dietetic Association’s Complete Food and Nutrition Guide. 3rd ed. Hoboken, NJ: John Wiley & Sons.

Other Resource

Weight Watchers Program: (800) 651-6000.

Websites

American Dietetic Association: www.eatright.org

DASH diet: www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf

Dietary Guidelines for Americans (2005): www.health.gov/dietaryguidelines/dga2005

Dietary Reference Intakes (2004): www.iom.edu/CMS/3788/3969/18495.aspx

Eating Healthy with Ethnic Food: www.nhlbi.nih.gov/health/public/heart/obesity/lose_wt /eth_dine.htm

Eating Healthy When Dining Out: www.nhlbi.nih.gov/health/public/heart/obesity/lose_wt /dine_out.htm

Food Intake Patterns: www.mypyramid.gov/downloads/MyPyramid_Food_Intake_Patterns.pdf

Food Pyramid: www.mypyramid.gov

Food Pyramid Calorie Intake Levels: www.mypyramid.gov/downloads/MyPyramid_Calorie _Levels.pdf

Food Pyramid Personal Diet Tracking: www.mypyramidtracker.gov

Just Enough for You (About Food Portions): win.niddk.nih.gov/publications/just_enough.htm

Low-Fat, Low-Cal Alternatives: www.nhlbi.nih.gov/health/public/heart/obesity/lose_wt/lcal_fat.htm

Mayo Clinic: www.mayoclinic.com