WHEN I WAS ON THE CROSS-COUNTRY BIKE RIDE I described earlier in the book and pulled into Chicago, I got to ride right onto the set of The Oprah Winfrey Show while it was in the middle of taping. I didn’t even get off the bike (a surprise guest, just passing through!) but stopped to chat with Oprah. “Wow,” she said, “I hear you’re drinking gallons of orange juice. Is it true you’re eating eight to nine thousand calories a day? That’s my dream.” “I know it is,” I replied, and I couldn’t resist adding, “but your dream doesn’t involve riding a hundred miles a day. That’s your biggest nightmare!”
Who wouldn’t like to eat all that they wanted every day? Maybe not eight to nine thousand calories, but it would be nice to eat whatever you felt like without any worries about the repercussions. Because of my profession people often expect me to be a perfect eater. I’ll go out with friends or business associates and besides watching every morsel I put in my mouth, they’ll become very self-conscious about what they’re ordering. But not only do I enjoy food, I like to see other people enjoying food, too.
Once when I was appearing on a local morning show, I talked with a variety of other interesting guests in the greenroom of the television station as we waited for our respective turns in front of the camera. When I heard my name called, I headed out onto the stage.
Earlier, I had noticed that there was a huge tray of doughnuts sitting on a table in the middle of the greenroom. While I was chatting with everyone, nobody had touched them, but when I came back into the room after my appearance, I noticed there wasn’t so much as a crumb left. It looked like someone had taken a vacuum cleaner to the tray. My publicist, who had accompanied me to the TV station and saw me looking at the tray, began to laugh. “The second you walked out, they dove into those doughnuts like there was no tomorrow.” Obviously, they had been too intimidated to eat in front of me.
The truth is, I love to eat a variety of foods and I love dessert (okay, maybe I don’t eat doughnuts, but I find it difficult to turn down any type of pie). I’m human. I battle cravings just like anyone else. Over the years, I’ve certainly improved my diet. I eat better now than I did in my twenties and thirties, but that’s because I have to. You just can’t get away with as much when you get older, and if you do make the effort to eat more moderately and nutritiously, there are plenty of life-lengthening and anti-aging benefits to be had.
It’s estimated that up to a third of cancer cases, half of heart disease cases, and up to 90 percent of cases of type 2 diabetes are entirely related to less-than-healthy diets as well as how much body fat a person is carrying around. On the flip side, many societies known for their longevity boast diets that are nutrient-rich and far more reasonable in calories than those diets associated with disease. The evidence that you have a greater likelihood of living a longer, higher-quality life if you eat well and moderately is undeniable.
One thing we know about the aging process is that it is accompanied by a slowdown in the metabolic rate (the rate at which you burn calories). As I explained in the previous chapter, exercise can go a long way toward preventing that slowdown; however, most people have to be more careful about how many calories they take in once they approach their forties, or they gain unwanted pounds. I wish I could say that eating however much you want is one of the privileges of aging, but in fact you need to stay extra vigilant about calories as you grow older. There’s even some intriguing research, which I’ll discuss here, showing that cutting way back on calories can extend your life.
At least as important as the quantity of your food is the quality of your food. There are, of course, the basic building blocks of a nutritious diet: healthy fats, high-quality protein, whole grains, fruits and vegetables. But beyond that, there are also certain foods known to have potent antioxidant powers capable of helping to reduce inflammation and disarm cancer-causing agents, as well as foods that can help lower cholesterol, preserve bone, and keep your brain sharp. Integrate these into your diet and you can greatly enhance your ability to counter various aspects of the aging process.
On the following pages, you’ll find an anti-aging eating plan based on all the tenets I just mentioned: don’t eat too much, build your diet on healthy staples, and accent it with superfoods. In addition, Tufts researcher Diane L. McKay will weigh in on supplements and how to fill in any potential gaps in your nutrient needs.
EATING FOR HEALTH AND LONGEVITY
Thanks to a whole body of research looking at the connection between certain types of diets and longevity as well as how particular foods affect disease risk factors, we know how to define anti-aging eating. For instance, several epidemiological studies have found that the traditional diets of people living in Mediterranean countries and islands off Japan (Okinawa) seem to confer amazing life-lengthening benefits. Other studies have found that when groups of certain foods are included in a healthy diet, they work together to lower the risk of heart disease. We also now have a lot of information about superfoods, foods from every category that have high levels of disease-fighting compounds and/or have been shown to exact some beneficial changes in the body.
The 20 Years Younger Diet draws from all these sources, but before I tell you more about it, a little background on three of the diets that in part inspired this plan is in order.
The Okinawan Diet is based on research looking at the eating habits and life span of the inhabitants of the Ryukyu Islands (Okinawa is only one of the 161 islands in this string off the coast of Japan, but because it’s the largest, its name is used comprehensively). It’s well known that Japanese people have half the heart disease rate and about a quarter of the breast and prostate cancer rate as Americans. They also have lower rates of diabetes and Alzheimer’s-related dementia. But in Okinawa, the rates for all these chronic diseases are even lower. Okinawa also has the largest concentration of centenarians—people age one hundred or older—of anywhere in the world.
Their secret? When Okinawans leave Japan and immigrate to the United States or other countries with a Western-style diet, they gradually, with each succeeding generation, take on a similar risk for chronic disease as everyone else living in that country. “So these people aren’t living longer because they have such fabulous genes,” says D. Craig Willcox, MHSc, PhD, a professor at Okinawa International University and author of The Okinawa Program. “They’re living longer because they eat a healthy diet, and stay active and lean.” As co-principal investigator of the Okinawa Centenarian Study, Willcox, along with his twin brother, Bradley Willcox, MD, a clinical associate professor at the University of Hawaii, has been tracking the habits of the age-defying Okinawans.
The elderly Okinawans studied by the Willcoxes ate a diet fairly high in carbohydrates, but their carbohydrates came mostly from vegetables and whole grains plus a little fruit (in other words, they weren’t packing away lots of baked goods and other junky carbs). They also ate a lot of tofu—even more than in other parts of Japan—and their other protein mainstay was fish. Red meat wasn’t regularly on the menu, and when it was, it was generally used as a garnish rather than as the main dish. The types of fat the elderly Okinawans consumed were healthful, something else that set them apart from typical American eaters. Dr. Willcox sums it up. “The reason this way of eating works is because it douses your body with protective phytoactive plant compounds while minimizing the unhealthy stuff like saturated fat, trans fat, white flour and heavily processed foods. In the United States, we eat exactly the opposite way.” Another major difference: Okinawans eat about 1,900 calories per day compared to about 2,500 for the average American. What’s more, those within the Okinawan population who eat about 15 percent less than average have the longest lives.
The life span of people in Greece and many of the other countries along the Mediterranean Sea rivals that of the Okinawans. The diets in the different countries ringing the Mediterranean aren’t identical—for instance, pasta is a staple in Italy, whereas rice and potatoes are more popular in Greece—but they have a lot in common. You might hear their way of eating referred to as the “Mediterranean diet,” but given the differences I think it’s more appropriate to call it the Mediterranean style of eating. And when I talk about this style of eating, I’m talking about the traditional pattern, no matter which country, of eating plenty of olive oil, a variety of whole grains, lots of fruits and vegetables, and moderate amounts of high-protein foods, mainly fish, with little meat.
There are many differences between the Mediterranean-Style Diet and the Okinawan Diet. They incorporate different types of oils and different fruits and vegetables, and the Okinawans eat no dairy products. But both diets offer similar benefits. Mediterranean countries such as Spain, Italy, and France have about half the rate of death due to heart disease as the United States. And if you already have heart disease, switching over to a Mediterranean-style diet is proving to be a potentially lifesaving move. The Lyon Heart Study of French men and women who’d had one heart attack found that those who followed a Mediterranean-style diet for four years had a 50 to 70 percent lower risk of having a second heart attack than those who followed a diet that was closer to an American diet.
One reason the Mediterranean-Style Diet lowers the risk of heart disease is that it reduces cholesterol, inflammation, and the likelihood of getting type 2 diabetes (diabetes doubles or triples heart disease risk). People who switch to the Mediterranean way of eating lose more weight and have better blood sugar control, two risk factors for diabetes. Followers of the Mediterranean-Style Diet also have lower rates of colorectal, breast, prostate, pancreatic, and endometrial cancers, and a few studies suggest that the diet may even help prevent age-related brain deterioration.
One study tracking older New Yorkers for four years found that those who closely adhered to a Mediterranean pattern of eating were 40 percent less likely to develop Alzheimer’s disease. French researchers have also found that the diet helps overall cognitive performance and memory. “These findings, though preliminary, show that eating a Mediterranean-style diet may not only affect the risk for Alzheimer’s disease, but also put the brakes on other forms of cognitive decline,” says Catherine Féart, PhD, of Université Victor Segalen in Bordeaux, France, who led the French study. “Because dementia can take decades to develop, and the Mediterranean diet may have a long-term beneficial effect, it seems that this dietary pattern, and its associated lifestyle, is an optimal dietary strategy if you want to protect your health, including your brain.”
A third diet with important benefits for anyone attempting to fight aging is called the Portfolio Diet. University of Toronto researchers asked people to include a “portfolio” of cholesterol-lowering foods such as almonds and eggplant in their diet. Each of the foods had only mild cholesterol-lowering effects on its own, but together they proved to pack a big punch, lowering LDL (bad) cholesterol in the study subjects by 20 percent or more, significantly cutting the risk of heart disease. These foods—I’ll tell you what they are as you go along—are worth working into your diet, too.
Whereas the Portfolio Diet is virtually a vegan diet (it contains a little nonfat milk and yogurt and its creators encourage the use of plant proteins as much as possible), the Mediterranean and Okinawan diets are not vegan or even vegetarian. They’re good examples, though, of how judicious consumption of animal foods can still be healthy if you also keep other sources of saturated fat to a minimum, moderate your intake of sodium and sugar, and consume lots of fruits and vegetables.
The Portfolio Diet, the Okinawan Diet, and the Mediterranean-Style Diet collectively tell us a lot about anti-aging nutrition. Yet they have drawbacks, too. Chief among them is that, with our American palates, which are used to the melting pot style of eating (a little Chinese one night, a little Italian the next, some Mexican-influenced cuisine the night after that), following any one of those diets to the letter could get tedious. One of the wonderful things about American markets these days (and that includes farmers’ markets and the wide range of ethnic markets as well) is that we have an abundance of foods to choose from, many of which fall into the superfoods category that I talked about earlier. I’m all for taking advantage of that abundance as much as possible, and the 20 Years Younger Diet helps you do so while still giving you the benefits of the Portfolio, Okinawan, and Mediterranean-Style way of eating. Beginning here, you’ll find two weeks’ worth of menus that draw on all three of these anti-aging diets, mixing in a healthy dose of longevity-promoting superfoods and topping it all off with a dash of convenience (no ingredient is too hard to find or difficult to make). It’s the perfect marriage of science and pleasurable eating: a nutritious modern meal plan with enough variety to keep it interesting.
The menu plans will give you initial direction, but it’s important to be able to create your own healthy menus. The 20 Years Younger Diet guidelines in the following section will help you with that. If you’ve been eating poorly, you’re going to feel the effects of shifting to this cleaner and more nourishing diet immediately. You’ll have more energy, your head will feel clearer, and even your skin will look brighter. If you’re already eating fairly nutritiously, the recommendations here will help you fine-tune your diet, showing you how to pack it full of the foods we know can help you live longer and age well. I’ll also be continually updating the diet on my website, www.20YearsYounger.com.
THE 20 YEARS YOUNGER DIET
One of the keys to successfully changing your eating habits in order to work toward any goal (be it weight loss, a lower cholesterol level, or overall health and longevity) is making rules for yourself. When you have these rules in place, decision-making about food is simply easier. You know what you can and can’t eat and how much food you should have on your plate. I’m not saying that you can never deviate from your nutrition rules, but you’ll find it considerably easier to stay on track day to day if you have a framework for eating. To that end, here are the guidelines for anti-aging eating. It’s a compilation of what to eat and what not to eat, how to work variety into your diet, and how to sprinkle it all liberally with anti-aging superfoods.
The Guidelines
At each meal, make sure half of your plate is covered with vegetables and/or fruit.
For as many meals as possible, the starch on your plate should be either a whole grain (such as whole wheat bread or brown rice), potatoes, sweet potatoes, or legumes (like black beans, pinto beans, or lentils). When you opt for potatoes, make sure they’re not fried.
Your high-protein choices should be mostly fish, chicken, or soy (see here for exceptions to the soy recommendation). Eat red meat no more than three times a month.
Use mostly olive oil and canola oil.
Avoid partially hydrogenated oils (trans fats—see here and here) and limit saturated fat.
Choose nonfat or 1% milk or yogurt, or calcium- and vitamin D–enriched soy milk.
Stick to the treat limit for your calorie level (see chart here); that’s 150 calories per day of foods high in sugar (like candy) or salty snacks (like chips) if you’re taking in 1,700 calories per day; 200 treat calories on the 2,000-calorie diet, and 250 on 2,500 calories. Bear in mind that the meal plans are full of examples of healthier treats.
Eliminate or severely limit (no more than twice a month) fried food, soda, or other sugary drinks (like heavily sweetened iced tea and juice “drinks” and punches, which contain very little juice). It’s okay to have four ounces of 100 percent fruit juice daily as one of your fruit servings, but any more than that counts as part of your treat calorie allowance. If you decide to have a soda or other sugary drink, that counts as treat calories, too.
The Plan
When you look at the plan below, you’ll see that it’s divided up into food groups. Under each group, you’ll find specific serving recommendations—you don’t have to follow these to the letter, but as long as you’re close, your diet will be longevity-enhancing. I’ve also included a list of superfoods that represent the best of the best in the group. Superfoods aren’t the only foods you can eat in each category, but opt for them as often as possible. Most of the foods on the list are available in your local supermarket or health food store.
The plan is written to include daily calorie levels ranging from 1,500 to 2,500. How many calories are right for you? The “What’s My Calorie Level?” chart below will help you figure out where to start, and I’ll include a range of servings recommendations under each category of food so you can see how your calorie level plays out in practical terms. Bear in mind that it may take some trial and error for you to find the calorie level that works for you, whether you’re trying to shed pounds or just maintain your weight.
If you’re going to have to make a lot of changes in your present diet to switch over to this one, you could get overwhelmed. My suggestion: Start by increasing the amount of fruits and vegetables you eat—that alone can have an amazing impact on your health. Do this for a few weeks, then make your next move. Change the fats that you’re eating, then after a few weeks try to weed salty snacks and excessive sweets out of your diet. Keep up the steps until you’ve mastered all the principles of anti-aging eating.
What’s My Calorie Level?
Based on your weight, height, age, exercise level, and how fast you tend to burn calories, your daily calorie needs are very individual. Someone of your exact height, weight, age, and gender who exercises just as much as you do might need a few hundred calories more or less per day than you do. So, keeping in mind that the guidelines below are flexible, use them as a starting point. If you’re feeling too hungry or are losing weight too fast (or unnecessarily), move up a calorie level. If you’re feeling too full or not losing the weight that you need to lose, drop down a calorie level.
| If you’re… |
And your activity level is… |
Try this daily calorie level… |
| A woman maintaining healthy weight |
Sedentary |
1,500 |
| A woman who wants to lose weight |
Sedentary |
1,500 or lower |
| A woman maintaining healthy weight |
Level I |
1,700 |
| A woman who wants to lose weight |
Level I |
1,500 |
| A woman maintaining healthy weight |
Level II |
2,000 |
| A woman who wants to lose weight |
Level II |
1,700 |
| A woman maintaining healthy weight |
Level III |
2,500 (possibly higher; see here for ways to add calories) |
| A woman who wants to lose weight |
Level III |
2,000 |
| A man maintaining healthy weight |
Sedentary |
1,700 |
| A man who wants to lose weight |
Sedentary |
1,700 or lower |
| A man maintaining healthy weight |
Level I |
2,000 |
| A man who wants to lose weight |
Level I |
1,700 |
| A man maintaining healthy weight |
Level II |
2,500 |
| A man who wants to lose weight |
Level II |
2,000 |
| A man maintaining healthy weight |
Level III |
2,500 + (see here for ways to add calories) |
| A man who wants to lose weight |
Level III |
2,500 |
THE 20 YEARS YOUNGER DIET GROCERY LIST
Fruit
2 to 4 servings daily
Serving = a medium-size fruit (like an orange) or half a cup of berries, grapes, or chopped fruit.
Superfruits
ACAI BERRIES, BLUEBERRIES, BLACKBERRIES, STRAWBERRIES, AND RASPBERRIES. Just a handful or two of berries on your cereal or oatmeal in the morning turns breakfast into brain food. Rich in polyphenols, phytonutrients that have anti-inflammatory and antioxidant powers, berry extract has been shown, through animal studies at the USDA Center on Aging Research at Tufts University, to improve memory by protecting brain cells from age-related decline. “We have little housekeepers in the brain called microglia, which clean up the debris that would otherwise interfere with brain cell function,” explains Shibu Poulose, PhD, a molecular biologist at the USDA/Tufts lab. “As we age, these housekeepers get sloppy, leaving debris around and even misdirecting their clean-up efforts on healthy cells, damaging them. Our studies indicate that extracts of blueberries, strawberries, and acai berries may restore microglia back to a functioning level.” Among berries’ other benefits is helping to lower cholesterol. Strawberries and raspberries also contain ellagic acid, a phytochemical that has anticancer properties.
CITRUS. We’ve long known that lemons, limes, oranges, and grapefruit are rich in vitamin C, good enough reason not only to eat citrus for snacks and desserts but to use it in cooking as well. (Lemon-based salad dressings, fish topped with an orange and onion salsa, and avocado and grapefruit salads are just a few of the ways to work citrus into meals.) Citrus fruits also contain a group of compounds called flavonoids, which are proving to be potent cancer and heart disease fighters. One of these flavonoids, naringenin, found in very high amounts in grapefruit, can stimulate production of SIRT1, an enzyme that appears to slow aging.
POMEGRANATES. Suddenly, pomegranate is everywhere. Pomegranate juices line store shelves, pomegranate extract is infused in tea, dried pomegranates are mixed into cereals and trail mix—you get the picture. Though pomegranate has long been used in traditional medicine in India, Greece, and the Middle East, scientists are now discovering that it holds promise in preventing clogged arteries and protecting against prostate and other types of cancer.
GRAPES. You hear a lot about the health benefits of wine, but what is wine made of? Grapes, and for my money, going right to the source is the best idea. Red and purple grapes get their pigment from anthocyanins, the same beneficial compounds found in blueberries and blackberries. Green grapes are higher in a compound called flavan-3-ols, which fight cancer and protect the nerves. Grapes of all colors may protect against heart disease and are also rich in a number of phytonutrients. The two considered most effective are proanthocyanidins and resveratrol, which has been making a lot of news lately because it’s believed to turn on the cells’ own survival mechanisms. Some scientists believe it shows promise for the prevention of many age-related conditions, including Parkinson’s and Alzheimer’s disease, inflammation, diabetes, and cardiovascular disease. Resveratrol is mainly found in the grape skin; proanthocyanidins are found only in the seeds.
Vegetables
4 to 8 servings daily
Serving = 1 cup raw greens such as spinach or lettuce or ½ cup chopped raw or cooked vegetables
RULE OF THUMB: Vary the type and color of your vegetables in order to consume the most phytonutrients, vitamins, and minerals. Have cruciferous vegetables at least three times a week and the others on this list as often as possible.
Supervegetables
CRUCIFEROUS VEGETABLES. Arugula, bok choy, broccoli, broccoli sprouts, Brussels sprouts, cabbage, cauliflower, collard greens, horseradish, kale, kohlrabi, mustard greens, radish, rutabaga, turnips, turnip greens, and watercress are cruciferous vegetables. Cruciferous vegetables turn off many people, but maybe that’s because they haven’t had them prepared properly. In Mediterranean countries, they’re often simply sautéed with olive oil instead of steamed, the way they’re commonly served here. Sautéing gives them much greater flavor, which is important, because you want to eat as many cruciferous vegetables as you can: They all share cancer-fighting compounds called isothiocyanates, which may disable some of the cancer-causing substances in tobacco smoke and help remove carcinogenic substances before they can damage DNA. Sulforaphane, an isothiocyanate found in broccoli, has even been shown to kill cancer cells.
EGGPLANT (PURPLE SKIN VARIETY). Eggplant is high in viscous fiber—the type that helps trap fat and cholesterol and whisk it out of the body. That’s why it’s a staple of the cholesterol-lowering Portfolio Diet. Eggplant’s purple skin is also a great source of anthocyanins, which give blueberries some of their healing properties. Be careful how you cook eggplant. It sops up oil like a sponge, so pan-frying isn’t the healthiest way to prepare it. Instead, slice the eggplant, spray it with oil, and bake it in the oven. You can also bake the entire eggplant in its skin, then peel it afterward.
PURSLANE. You can find this green in farmers’ markets in the summer, and it might even be in your backyard, growing alongside your grass. Eaten in some of the Mediterranean countries and in the Middle East as a salad green, it has unusually high amounts of omega-3 fatty acids for a vegetable (see here for more on omega-3s). A 3½-ounce serving (about 2
cup) contains 300 to 400 mg of omega-3, covering about a third of your daily requirement. It’s also high in melatonin, which may help you sleep more soundly.
SEAWEED. There are many types of seaweed, and their nutritional attributes vary. Those that show up regularly in Okinawan cuisine include the following:
Kombu: Okinawans use this mild-tasting seaweed to make broth (dashi). It’s rich in heart- and bone-protecting magnesium. Like wakame (below), kombu contains fucoidan, an antioxidant that in test-tube studies kills cancer cells.
Hijiki (or hiziki): Rich in both potassium and magnesium, its tender, dark, curly leaves are often part of a seaweed salad mix or served alone as a salad in Japanese restaurants. You can also buy it dried and turn it into a salad at home.
Wakame: Wakame is the green vegetable traditionally swirling around in miso soup. It’s rich in manganese (which is part of the body’s own antioxidant defense system) and folate (good for the heart and a cancer fighter). The only downside is that it’s very high in sodium, which is why the tofu and miso soup here substitutes kombu or hijiki for wakame.
To find seaweed, check the Asian section of your supermarket or visit an Asian market. You can also buy it online. Bear in mind that seaweed isn’t just for cooking. Many markets now carry snack packs of seaweed that you can eat just like crackers (though with far fewer calories).
MUSHROOMS. We’ve known for a while that mushrooms have a lot going for them—B vitamins, copper, and phytonutrients that boost immunity and help prevent plaque formation in arteries—but grocery stores are now also starting to carry mushrooms that are rich in vitamin D. Since vitamin D is hard to get from food, this is big news. The mushrooms are exposed to UV light so that they produce vitamin D (just as we do). One cup of these light-exposed portobello mushrooms provide 384 IUs of D, about 64 percent of a day’s requirement. If you can’t find these specialized mushrooms, you might want to opt for chanterelles or morels, which have a lot of naturally occurring D, or shiitakes, which are eaten regularly in Okinawa. Test-tube studies show that shiitakes ward off disease-causing microbes and kill cancer cells.
TOMATOES. If you can eat a fresh, vine-ripened tomato, you’re getting the best of both worlds—life-enhancing flavor, life-extending nutrients. But don’t give up on tomatoes if you can’t find tasty, fresh ones. Both fresh and canned tomatoes and tomato sauce are rich in lycopene, a potent antioxidant linked to a reduced risk of cancer. The redder the tomato, the more lycopene it contains, and cooked tomatoes contain more lycopene ounce for ounce than raw and the lycopene in cooked foods is better absorbed by the body. Tomatoes are a major component of the Mediterranean-Style Diet, and a number of studies in the United States, Italy, and elsewhere have found that people who eat the most tomatoes are at lowest risk for heart disease and prostate cancer.
Herbs and Spices
Try to incorporate into your diet as often as possible.
There are no specific serving sizes; use in amounts that enhance but don’t overpower the taste of your food.
Super Herbs and Spices
BASIL, CILANTRO (CORIANDER), DILL, GINGER, MINT, OREGANO, PARSLEY, ROSEMARY, AND THYME. In general, herbs and spices contain a treasure trove of compounds that fight infection and chronic diseases. I singled out these nine because they’re popular in Mediterranean and/or Asian cuisine. While fresh herbs are going to have higher levels of protective compounds, for the most part, dried herbs retain enough to be helpful. The dark green herbs are rich in carotenoids, linked to a lower risk of several types of cancer. Basil, oregano, mint, parsley, rosemary, and thyme contain rosmarinic acid, which fights infection and inflammation and has been shown to fight blood clots, a major cause of strokes and heart attacks. Ginger, long known to help fight nausea, also has clot-fighting abilities and is anti-inflammatory.
Basil, cilantro, dill, mint, and parsley can be used liberally in salads—up to a quarter cup of each per four cups of other vegetables is a good ratio. Thyme, oregano, and rosemary have a stronger taste, so they stand up well to cooking (for an example, try the Braised Chicken Legs in Red Wine with Lentils, Fennel, and Kale here). Add sliced ginger along with garlic to a stir-fry; chop or grate it for a sesame-oil-and-vinegar-based salad dressing or marinade. To make ginger tea, simmer a 2-inch piece of ginger, sliced into 4 pieces, in 1½ cups of water for ten minutes.
CINNAMON. Perhaps because we associate it with not-so-good-for-you treats (those giant cinnamon rolls sold in airports come to mind), cinnamon is hardly ever thought of as a healthy spice. But research shows that it has many benefits, including an ability to help combat insulin resistance. Some studies are indicating that cinnamon also reduces inflammation, can help prevent formation of AGEs (for more on these destructive compounds, see here), and target and eradicate cancer cells.
There are plenty of ways to get cinnamon into your diet that don’t involve mammoth-size pastries. It’s often used in Moroccan recipes, and it’s delicious on a baked apple or in applesauce. Richard Anderson, PhD, a research chemist with the U.S. Department of Agriculture’s Diet, Genomics, and Immunology Lab in Beltsville, Maryland, who has studied cinnamon, suggests soaking a cinnamon stick in hot water and drinking it like tea, or adding ground cinnamon to coffee before brewing. If you have diabetes or pre-diabetes, consuming one half teaspoon of cinnamon two times per day may help you control your blood sugar, and similar amounts may decrease AGEs and inflammation in the body. If you can’t find a way to work it into the foods you’re eating, you can also buy cinnamon capsules at natural food stores.
GARLIC. Garlic has an outsize reputation as a superfood—you can find claims that it prevents everything from the common cold to heart disease. So what’s the truth? We do know that raw and cooked garlic is linked to a lower risk of stomach cancer and may have general immune-boosting effects. As for other benefits, according to Karin Ried, PhD, a research fellow at the University of Adelaide, Australia, who’s been studying garlic, different forms of garlic have different effects. “Our review of the research found that garlic supplements—but not raw or cooked garlic—can help bring down blood pressure in people with high blood pressure,” says Dr. Ried. “It’s less clear whether garlic, supplements or food, reduces cholesterol; the studies are conflicting.”
TURMERIC (IN CURRY POWDER OR ALONE). If you like Indian food, you’re in luck. This staple of South Asian cuisine gives curry its vibrant yellow color (it’s also used to color American mustard). Turmeric and one of the phytonutrients it contains, curcumin, are powerful anti-inflammatory agents and antioxidants. Some research shows that they both can kill cancer cells; curcumin has also been shown to clear amyloid plaque in the brains of mice, indicating that it may have potential in fighting Alzheimer’s disease. A number of human studies are currently under way examining curcumin’s effects on preventing and treating cancer and as a therapy for psoriasis as well as Alzheimer’s.
Grains, Legumes, and Starchy Vegetables
5 to 8 servings daily, and have at least one serving at each meal, if possible
Serving = one slice of 100 percent whole grain bread; ½ cup cooked potatoes, corn, sweet potatoes, peas, or whole grains (like oatmeal, whole grain pasta, or bulgur wheat); cup cooked legumes or brown rice
In addition to their other nutritional virtues, the grains recommended here and used in our meal plans are all whole grains, which are much higher in nutrients and fiber than refined grains. High-fiber foods are linked to lower body weight (possibly because they fill you up with fewer calories) and also fight chronic diseases in several ways, among them by lowering cholesterol. Whole grains and starchy vegetables also have a low glycemic index. The glycemic index (GI) is a 1-to-100 ranking of the extent to which a set amount of carbohydrate raises blood sugar. Low GI foods elicit the slowest and smallest rise in blood sugar; they have a GI of 55 or under. Medium GI foods fall into the 56 to 69 range and high GI foods are in the 70 to 100 range. Ideally, most of your carbs will fall into the low or medium levels, because eating this way has been linked to reduced risk for heart disease, diabetes, and obesity. The health benefits come in part because low-GI foods help keep blood sugar and insulin levels in check and keep you feeling fuller longer. One way to lower the glycemic index even further is to marinate them in or serve them tossed with a vinaigrette. Vinegar seems to encourage the flow of sugar from the blood to your cells, which helps keep blood sugar down.
Super Grains, Legumes, and Starchy Vegetables
BARLEY. The same thing that makes a mushroom barley soup so thick and hearty—a type of fiber called beta-glucan—gives barley its health benefits. Beta-glucans form a gel around food particles in your gut, slowing the absorption of sugar and starch and a corresponding slow rise in blood sugar. Preventing blood sugar spikes may help reduce your risk for pre-diabetes and type 2 diabetes, and helps control blood sugar once you have one of these conditions. Beta-glucans also slow the absorption of fat, and may actually carry fat and cholesterol out of the body before they’re absorbed, thus lowering blood cholesterol. Once they’re digested, the chemistry of beta-glucans seems to also reduce the body’s own production of cholesterol. Think about using barley not just in soups or side dishes but also in grain salads, breads, and risottos.
BLACK RICE. In China black rice used to be called “forbidden rice” because it was reserved for emperors and noble people. Happily, it’s now available to all of us—happily, because it’s loaded with the same health-promoting anthocyanins as blueberries, blackberries, and red and purple grape skin. In Asia, black rice is used to make noodles, sushi, and pudding, but you can simply throw it in a pot or rice cooker and cook it like any ordinary type of rice. Many high-end markets now carry black rice, and you can find it online.
BULGUR WHEAT (CRACKED WHEAT). A staple in Middle Eastern countries, bulgur is wheat in whole grain form. What makes it different from and even healthier than whole wheat flour is its coarseness. The thicker the cut of a whole grain, the harder your body has to work to break it down, and the smaller and shorter the rise in your blood sugar will be: cooked bulgur wheat has about half the glycemic index as whole wheat bread. Bulgur is also rich in heart-protective vitamins and minerals such as vitamin E, folate, selenium, and magnesium. The most common way to eat bulgur is in tabbouleh, a Middle Eastern grain salad usually made with a slightly finer cut of bulgur and tossed with parsley, mint, lemon juice, and olive oil. Use the coarser cuts of bulgur to make pilaf (it cooks up just like rice) and combine it with beans to make veggie burgers.
STEEL-CUT OATS. Like barley, oats are a great source of beta-glucans and have all the same cholesterol-lowering effects. Opt for the steel-cut version of oats rather than flaked oats. It takes longer to cook, but this thicker and coarser cut gives it a lower glycemic index.
LEGUMES (LENTILS; CHICKPEAS; PINTO, WHITE, AND BLACK BEANS). Legumes are rich in both fiber and protein. They also have other attributes, including B vitamins, magnesium, calcium, and iron, and a host of phytonutrients. Saponins, a category of phytonutrients found in legumes, reduce cholesterol levels and help fight cancer. Legumes and rice are eaten around the world in one form or another, and they make a perfect meal. It’s easy to cook legumes, but if you end up buying canned, get the low-sodium or no-salt-added varieties. If those versions aren’t available, be sure to rinse canned beans well before using to reduce the sodium.
SWEET POTATOES. The sweet potato is where the Okinawan Diet and the American diet cross paths: Many Okinawans eat sweet potatoes daily, and, of course, they’re readily available in the United States as well, although all too often are served only on Thanksgiving. Don’t just think of them as a holiday vegetable. Mash them, bake them, top them with a little maple syrup, use them in soups, but whatever you do, eat them often. Sweet potatoes contain nearly every vitamin and mineral and boast a host of phytonutrients. A medium sweet potato (about 100 calories) provides 550 percent of your daily requirement of vitamin A in the form of beta-carotene. Beta-carotene from foods (as opposed to supplements—see here) is linked to a lower risk of cancer and heart disease.
Milk/Soy Milk Products
2 to 3 servings daily
Serving = 1 cup milk or calcium-fortified soy milk; ¾ cup plain yogurt
I recommend nonfat and 1% milk and yogurt throughout this plan because milk is the main source of calcium in the American diet and these foods are also rich in magnesium and potassium. These fat-free and very low fat products ensure you don’t overdo calories or saturated fat. They’re also associated with a decreased risk of osteoporosis and colon cancer. I’m stopping short of calling them superfoods because there is evidence that milk may slightly raise the risk of prostate cancer. Of course, anyone worried about this can switch to calcium-enriched soy milk, a perfect substitute.
High-Protein Foods
5 to 8 servings daily
Serving = 1 ounce fatty fish or dark meat poultry; 1½ ounces white fish or light meat poultry; 60 calories tofu, which works out to 1½ to 3½ ounces, depending on the type, so check labels; 1 to 1½ ounces tempeh (same thing—it varies); 
cup legumes
Your protein strategy: Have any of the fatty fish listed on the following page three times a week. Try to get in at least 12 ounces weekly, more if you like fish. Your other high-protein staples should be skinless poultry, eggs, egg whites, egg white products, and soy (tofu, tempeh, edamame). Though other legumes (such as black beans, pinto beans, and white beans) don’t have as complete a protein profile as soy, it’s fine to use them as your protein source for one meal daily. Limit your intake of red meat to no more than three times a month or less. This may seem Draconian if you’re used to eating meat several times a week, but my reasoning comes by way of many studies showing that frequently eating red meat raises the risk for colon cancer and increases the risk for heart disease. Processed meats such as hot dogs, bacon, pepperoni, and sausages, all high in saturated fat, are particularly unhealthful. Avoid them or eat them only occasionally.
Super High-Protein Foods
FATTY FISH (WILD-CAUGHT SALMON, TROUT, SARDINES). In general, fish is a healthy protein choice, but these fish are the top of the line. Not only are they richer in healthy omega-3 fatty acids (see here) than other types of fish, but they are also lower in mercury and other pollutants than many of the fish in the seafood case. The fish supply, including some fish farmed in other countries and imported, has become very contaminated, and I recommend that you be careful (visit the Monterey Bay Aquarium’s Seafood Watch website to keep updated on the safest fish and those that are sustainably fished: www.montereybayaquarium.org/cr/seafoodwatch.aspx).
Fish in general confers numerous health benefits. Regular fish consumption has been linked to a lower risk of dementia, and a Harvard University study tracking thousands of men found that those eating fish at least once a week were only half as likely to experience sudden cardiac death as those who ate no fish. In that study, all types of fish were beneficial, but fatty fish has the added benefit of having high levels of omega-3s. And these fish oils may not be the only heart-protective factor. Fatty fish are also low in saturated fat, and many contain vitamin D.
SOY (TOFU, TEMPEH, EDAMAME). As many people move away from red meat, they’re moving more toward soy, and with good reason. Soy is a good source of high-quality protein and unsaturated fat (both tempeh and edamame are also fiber rich) and has been shown to lower blood cholesterol. It may reduce the risk of certain cancers, although this is still uncertain (see “Is Soy Safe?” at left). One of the beauties of soy is that it comes in so many forms. Edamame are young green soybeans available in the frozen section of the supermarket (both shelled and in the pod). You can use them in stir-fries and soups and as a snack. Tempeh is made from cooking mature soybeans and adding a mold culture (cheese is made that way, too); grains are often also added. It has a pleasant, nutty taste and a satisfying chewy consistency. Tempeh works well in hot and cold foods and makes a great sandwich. Tofu is made from soy milk and comes in various consistencies. Firm tofu is great marinated and baked or in stir-fries; soft, silken tofu works nicely in soups (it’s often added to miso soup) or made into scrambles. There are also a lot of soy-based prepared foods on the market that are both healthy and convenient. Gardein, for example, makes a whole line of soy products that mimic chicken and beef.
EGG WHITES. The white of an egg is the perfect protein, with ideal levels of amino acids (the building blocks of protein). Whole eggs, of course, are very nutritious, too, but one large egg contains some saturated fat (1.5 g) and lots of cholesterol (211 mg)—almost all of it contained in the yolk. For most people cholesterol in food doesn’t raise blood cholesterol. But if you’re one of the few for whom it does cause a problem (you’d know it if you lowered your dietary cholesterol and your lab values improved), egg whites are a better choice than whole eggs. Even if you don’t have high cholesterol, if you’re eating a lot of eggs it’s a good idea to alternate egg whites and whole eggs to keep your saturated fat intake low. Also consider using an egg white product such as Better’n Eggs. The ready-to-use egg whites are convenient, they contain added vitamins and minerals, and they’re pasteurized so there’s no risk of salmonella.
Nuts, Nut Butters, and Seeds
1–2 servings daily
Serving = ½ ounce, about 2 tablespoons nuts or 1 tablespoon nut butter. All nuts are healthful because they have great fat profiles and contain phytonutrients, but the ones below are standouts.
Super Nuts and Seeds
ALMONDS. Packed with a laundry list of nutrients, phytonutrients, and healthy fats, unsalted almonds not only helped lower LDL cholesterol in the Portfolio Diet but were largely responsible for reducing blood pressure. Toss almonds into salads, eat them as a snack, add sliced ones to chicken or fish dishes, but use restraint. They’re healthy, but, like all nuts, still high in calories: an ounce has 170.
FLAXSEED. Flaxseed and flaxseed oil are the richest source of plant-based omega-3s and therefore offer all the benefits of these essential fatty acids. Flaxseed is also a good source of fiber (although flaxseed oil is not), and it contains phytoestrogens—the type of phytoestrogen in flaxseed is called lignan—so the same question that dogs soy (see “Is Soy Safe?,” here) dogs flaxseed as well. In an attempt to answer that question, scientists at the German Cancer Research Center in Heidelberg reviewed the research on lignans and breast cancer and concluded that postmenopausal women taking in higher levels of lignans have about a 15 percent lower risk of developing breast cancer, and that studies show no effect either way on premenopausal women’s risk.
There are a few things to keep in mind about flaxseed. You need to grind them to get all their benefits; your body won’t break down whole ones. Because omega-3s oxidize (go rancid) quickly, it’s best to buy whole flaxseeds, keep them refrigerated, then grind them in a coffee or spice grinder, a food processor, or high-quality blender. Grind in small batches (a week’s worth of the flaxseed called for in the 20 Years Younger Diet is about ½ cup). Place the ground flaxseed in an airtight container or plastic bag and store them in the refrigerator. You can sprinkle ground flaxseed on cereal, add to muffin, cookie, and bread recipes, and stir into yogurt and smoothies. Add flaxseed oil to sauces and salad dressings.
WALNUTS. Walnuts are a powerhouse of nutrients and a good vegetarian source of omega-3 fatty acids. They’re not quite as good as the type of omega-3s in fish, but your body can convert a portion of them into the more advantageous kind. Walnuts are also high in vitamin E, melatonin, and ellagic acid (see berries), and the fat in the walnuts may make it even easier for your body to absorb these compounds. One more reason walnuts belong in the superfood category: In conjunction with an overall healthy diet, they not only help lower LDL (bad) cholesterol levels but bring down the most artery-clogging type of cholesterol, called dense LDL.
Fats
4 to 7 servings daily
Serving = 1 teaspoon of oil, mayonnaise, or healthy spread (made without partially hydrogenated oil); 1 tablespoon light mayonnaise, light healthy spread, or regular salad dressing; 2 tablespoons light salad dressing; 
of a Haas avocado
NOTE: Nuts and nut butter can also be used as fats, so if you want more nuts than your allotted serving (see Nuts, Nut Butters, and Seeds above), go ahead—just count them as a fat serving. One tablespoon of nuts or 1½ teaspoons of nut butter is a fat serving.
Superfats
Fats are a confusing issue, so let’s talk about not just superfats but your approach to fats in general. Long vilified, fats are actually essential to health and longevity, but it’s important to distinguish the healthy ones from the ones that can do damage. There are two fats you need to watch: saturated and trans fats, both of which raise blood cholesterol levels. Limit saturated fat (found in animal foods) as much as possible and try to avoid trans fats (found in hydrogenated oils) completely.
One of the fats you do want in your diet is monounsaturated fat, the primary type of fat in olive oil. If you think you like olive oil, get this: Greeks currently take in an average of 100 cups of olive oil per year. All that oil contributes to longevity in a few ways. Among them: Anti-inflammatory compounds in olive oil called polyphenols help prevent cardiovascular disease and cancer. The monounsaturated fat in olive oil’s makeup—about 70 percent of its total fat—lowers levels of LDL (bad) cholesterol and helps prevent its oxidation. LDL oxidation leads to clogging and hardening of the arteries. The monounsaturated fatty acids in olive oil have also been linked to a reduction of body fat storage and a higher fat-burning rate in the five hours after having an olive oil–rich meal.
As wonderful as olive oil is, there may be times when you want a neutral-tasting oil. That’s where canola oil comes in. It also has a stellar nutrition profile—it’s lower in saturated fat than most other oils, has about the same level of monounsaturated fat as olive oil, and is a rich source of ALA, plant omega-3s, which I’ll tell you more about shortly. Studies show that using canola oil on a regular basis helps reduce LDL (bad) cholesterol. Others show that it slightly raises HDL (good) cholesterol.
Polyunsaturated fats, to varying degree, are also beneficial. Polyunsaturated fat is the dominant fat in most other vegetable oils. Among polyunsaturated oils are soybean oil, corn oil, and sunflower oil. These contain fatty acids known as omega-6s, which are the building blocks of cell membranes. While they don’t raise blood cholesterol, consumed in excess, omega-6s can cause inflammation and “thicken” the blood, making it more likely to form blood clots. That can lead to heart attacks and stroke, so you need to be cautious about overconsuming these particular polyunsaturates.
In a different category altogether is the type of polyunsaturated fat with the most anti-aging and overall health benefits: omega-3 fatty acids, found in fish oils and in some plant foods. They’re linked to a reduced risk of heart disease, cancer, and diabetes and are anti-inflammatory and integral to healthy brain function, and may even help ease depression. Some studies show that people with higher-than-average levels of omega-3s in their blood have a lower risk of dementia.
Omega-6 fatty acids compete with omega-3s for entry into cell membranes, the reason you want to keep the two in balance. We were designed to eat omega-3s and omega-6s in equal amounts, according to Artemis Simopoulos, MD, director of the Center for Genetics, Nutrition, and Health in Washington, D.C., who’s researched dietary fats extensively. “During our evolution, nearly all foods contained omega-3 fatty acids. But now, very few foods are good sources,” says Dr. Simopoulos. “For instance, game animals used to graze on grass and other wild plants, which made their meat rich in omega-3s; now cattle eat corn and other feed, which results in meat virtually devoid of omega-3s.” Instead of the 1:1 omega-6 to omega-3 ratio we were designed for, the typical American diet has a 16:1 ratio. By contrast, the traditional Greek diet has a ratio between 1:1 and 1:2, and the Japanese ratio is about 4:1.
The most potent types of omega-3s are those found in fish: eicosopentaenoic acid (EPA) and docosahexaenoic acid (DHA). However, alpha-linolenic acid (ALA), prevalent in plant foods, is still effective and important to include in your diet. Dr. Simopoulos recommends taking in 2,000 mg of ALA daily (slightly higher than that recommended by the Institute of Medicine), and at least 650 mg of EPA and DHA combined. The best way to reach that goal is to eat at least one omega-3-rich food daily. “And just to ensure you’re getting enough omega-3s, take a daily supplement of 1,000 milligrams,” advises Dr. Simopoulos.
Your Good Fat Guide
OKAY, BUT ONLY IN MODERATION
Foods high in omega-6s: corn oil, sunflower oil, safflower oil, soybean oil, peanut oil, and all the foods made from these oils, such as many salad dressings, sauces, and fried foods.
VERY GOOD
Foods high in plant-based omega-3, alpha-linolenic acid (ALA): flaxseed, flaxseed oil, walnuts, omega-3-enriched foods such as some eggs.
EXCELLENT
Foods high in monounsaturated fat: olive oil, canola oil, almonds, cashews, avocados. Also: foods high in EPA and DHA: fatty fish including bluefish, mackerel, trout, salmon, and sardines (these are also low in mercury, which, in excess, can cause a number of health issues including damaged nerves).
Healthy Treats
Between 150 and 250 calories daily (see here to see the amount that corresponds to your overall calorie level)
Serving sizes vary, so check labels to find the appropriate portion for your particular treat calorie limit.
Your sweets and treats strategy: We have a natural predilection for foods that are sweet, yet it’s also our Achilles’ heel. Too many sweets, of course, add up to too many calories, and they’re typically empty calories—that is, generally unaccompanied by any vitamins, minerals, or fiber. The one supertreat on this list—chocolate—compensates by providing a healthy dose of antioxidants. Two other treats—poached or baked apples or pears and fruit topped with slightly sweetened yogurt or tossed with a mix of citrus juice and honey—are good choices, too. Eat them in moderation to satisfy your sweet tooth without overindulging.
Supertreats
Cocoa powder and dark chocolate (over 50 percent cacao). Sometimes you luck out and a food that you really love is also good for you. That’s the case with cocoa and dark chocolate; their health benefits stem from compounds called flavanols, antioxidants that also stimulate your body to produce nitric oxide, which opens up arteries, reducing blood pressure. Nitric oxide also discourages plaque formation in the arteries, another way it protects the heart. Scientists became clued in to cocoa’s blood-pressure-lowering effects when they found that a Panamanian Indian tribe with a high cocoa consumption had virtually none of the age-related rise in blood pressure and kidney disease (a consequence of high blood pressure) found in most societies. Their cardiovascular death rates were also an astonishingly low 9 per 100,000 people compared to 83 per 100,000 in the rest of Pan-America. But when members of the tribe moved out of their villages and into urban Panama City, they ate much less cocoa and their heart disease rates shot up to those in the rest of the country.
Pure unsweetened cocoa is richest in flavanols, followed by dark chocolate (at least 50 percent cacao or, as it’s sometimes referred to, cocoa). Milk chocolate usually doesn’t have too many flavanols. The only real drawback to dark chocolate is that at 140 calories per ounce, it’s easy to rack up a lot of calories if you don’t carefully monitor your portion sizes. (Chocolate is also high in saturated fat, but it’s a saturated fat called stearic acid, which doesn’t raise LDL cholesterol and may lower blood pressure.) You can be a little more liberal with unsweetened cocoa: It only has 12 calories per tablespoon.
DON’T GET SWEET ON SUGAR SUBSTITUTES
Because maintaining a healthy weight can be critical to longevity, it might seem reasonable to use artificial sweeteners to help control calories. After all, you save 16 calories for each teaspoon of sugar, honey, fruit juice sweetener, or other calorie-containing sweetener that you replace with an artificial one. But it isn’t at all clear whether making the swap actually saves you calories over the long haul. In fact, some studies show that consuming sugar substitutes may actually cause weight gain. The San Antonio Heart study, for instance, tracked people who began the study with a similar body mass index (BMI; see here for an explanation). Seven to eight years later, the researchers found that those people who consumed the most artificial sweetener had a BMI one point higher than those participants who consumed very few artificially sweetened foods.
One explanation may be that sugar substitutes don’t satisfy in the same way that real sweeteners do. Sure, a diet soda tastes sweet and may gratify a sweet craving, but that’s not the only way your body reads satisfaction; it also keeps track of calories, and it knows when you’re trying to fake it out. Plus, artificial sweeteners like sucralose (brand name Splenda), aspartame (Nutrasweet), acesulfame K (Sunett), and saccharin (Sweet’N Low) tend to be incredibly sweet—sweeter than a natural sweetener. That can make you become accustomed to very sweet foods and drinks so that you crave cookies, cakes, and other high-calorie foods.
There is, too, the issue of safety. To my mind, we just don’t know enough, even if artificial sweeteners are approved by the FDA. Here’s what I recommend: If you drink traditional types of soda to excess and using artificial sweeteners helps you wean yourself off all that sugar, then it may be worthwhile to use them for a short time. But beyond that, you don’t need them. Work toward keeping your intake of sweet foods moderate, and when you do eat sweets, go for the real thing.
WHAT SHOULD YOU DRINK?
Beverages often get treated as an afterthought, but they’re an important part of a healthy diet. My suggestion: Drink at least 6 eight-ounce cups of water daily, and no more than about 4 cups of coffee or tea (caffeine tolerance is very individual; if you’re jittery or not sleeping well, these limits may be too high for you). Have as much herbal tea as you like. Wine, like any alcohol, is optional. If you do drink alcohol (see here), have no more than one drink daily if you’re a woman; no more than two drinks if you’re a man. Typical serving sizes are 8 ounces water; 8 ounces tea or coffee; 5 ounces wine; 12 ounces beer; 1½ ounces hard liquor. Here are some specifics about the beverages you may include in the 20 Years Younger Diet.
Plain water, sparkling water, or water with a splash of juice. The best thing you can drink is water, no question. It has no calories, and it helps keep every process in your body running smoothly. If you’re dehydrated you’re not going to get the most out of your workout—dehydration lowers your endurance. Water is what your body was designed to drink.
I find that people usually fall into two camps: those who love drinking water all day and those who find water utterly boring and really have to struggle to get in 6 cups a day. For those of you who need a little flavor, sparkling water with juice is the perfect solution, especially if you’re weaning yourself off soda. Simply add a tablespoon or two of your favorite juice (cranberry, pomegranate, and mango are all good choices) to a glass of sparkling water, stir, and sip.
Coffee. Coffee is what you might call a mixed bag. On the one hand, some research shows that people who drink a lot of coffee (5 to 7 cups daily) have a substantially lower risk of diabetes. This is likely due to compounds in coffee called chlorogenic acids, which help slow the rise in blood sugar. (Decaf may also lower the risk of diabetes.) Chlorogenic acids are also strong antioxidants that may protect against estrogen-related cancers. These antioxidants may be the reason that coffee drinkers have a lower risk for developing dementia, Parkinson’s disease, and Alzheimer’s, too.
Yet coffee also has its drawbacks. It may exacerbate ovarian cysts, and its effects on the heart are still an open question. And coffee, of course, can interfere with sleep; anything that keeps you from being well rested isn’t doing you any favors. To be on the safe side, follow the guidelines stated earlier—no more than 4 cups of coffee daily—to keep your coffee intake moderate and bear in mind that decaffeinated coffee can confer the same benefits as caffeinated without the big buzz.
Tea. Could tea be one of the reasons Okinawans live so long? Perhaps. It certainly has many healthful qualities. In general, tea drinkers have a lower risk of stroke and heart disease. Tea is also linked to a lower risk of Alzheimer’s and Parkinson’s diseases. In one study, people who drank two or more cups of black tea daily were 60 percent less likely to develop Parkinson’s. Tea drinkers are also at reduced risk for lung and colon cancers.
The key anti-aging ingredients in tea are phytonutrients called catechins. Green tea and black tea contain different types of catechins, but both types are antioxidants and anti-inflammatory agents, which help prevent clogged arteries and neutralize cancer-causing agents. Because the caffeine content of tea is one-third to half that of coffee, it’s safer for the heart and less likely to interfere with sleep. Nonetheless, pay attention to how you feel and cap your intake if you feel jittery.
Wine. Both red and white wine are consumed in moderation, and usually with meals, throughout the Mediterranean. Wine drinkers have a reduced risk of heart disease and death from any cause. This seems to be due to both the alcohol itself and the phytonutrients in wine, including anthocyanins, phenolic acids, and a polyphenol called resveratrol (see grapes here). Some scientists believe resveratrol shows promise for the prevention of many age-related conditions, including Parkinson’s and Alzheimer’s diseases, inflammation, diabetes, and cardiovascular disease.
Remember that the Mediterranean people get health benefits from drinking moderately. Excessive drinking reverses the rewards of wine (see “Can Alcohol Help You Live Longer—Or Shorten Your Life?” opposite).
WHAT NOT TO EAT: FOODS THAT AGE YOU
Just as certain foods slow down the aging process, others can speed it up, and you need look no further than the typical American diet: burgers, fries, white bread, sodas, candy, doughnuts, giant muffins, sweetened coffee drinks, buffalo wings, potato chips.
These foods are rife with substances that promote inflammation and oxidation, raise blood pressure and cholesterol levels, and damage DNA. In that way, they raise your risk for just about every chronic disease. Here are the killer compounds that you need to either avoid or limit:
Trans Fats
The main source of this type of fat is partially hydrogenated oil. This is an oil, such as soybean, put through a chemical process that solidifies it into margarine or shortening. These fats were at one time considered a healthier alternative to lard and butter, which are high in saturated fat. But now we know that trans fat is the most dangerous fat around. It promotes inflammation and the storage of intra-abdominal fat, and it raises LDL (bad) cholesterol while lowering HDL, the good kind.
YOUR STRATEGY: Always check the ingredient list for “partially hydrogenated oil.” Often you’ll find that foods containing this oil still state 0 g of trans fat on the nutrition label. That’s because a labeling loophole allows for a “0” if a product has under 0.5 grams of trans (or any other type of) fat. Taking in even one or two grams of this fat is considered too much, so you can see how eating only a few servings that contain just under half a gram can quickly add up. So put back on the shelf any product containing partially hydrogenated oil. At restaurants, skip pies—the crusts may be made with shortening—and pass on fried and heavily breaded foods. If you have a recipe that calls for shortening or margarine, look for the kinds that are made without any partially hydrogenated oils, such as the Bestlife buttery spread and the new Bestlife buttery baking sticks.
Saturated Fat
This fat lurks mainly (though not only) in foods of animal origin such as red meat, bacon, chicken skin, whole and 2% milk, and cream. Like trans fats, saturated fat promotes inflammation, especially if you’re overweight. It lodges in the fat cells and turns them into little inflammation factories, and this can ultimately lead to insulin resistance, heart disease, diabetes, and cancer.
If you need some numbers as guideposts, most people can get away with just under 10 percent of calories from saturated fat. The Okinawan and Mediterranean-Style Diets go a little lower—7 percent. This is also the amount recommended if you have heart disease. On a 1,500 calorie-per-day diet, 10 percent is 15 g saturated fat; on a 1,700-calorie diet, it’s 17 g.
YOUR STRATEGY: You can’t avoid this fat, as even healthy foods such as nuts, olive oil, and canola oil contain some saturated fat. But if you avoid the other sources mentioned above, you’ll automatically significantly reduce your saturated fat intake. Food labels are required to list the saturated fat content, so when buying any type of food—frozen foods, cheese, crackers, cereal, desserts—always compare labels and pick the items lowest in saturated fat.
Sodium
While a little sodium is critical to our health and survival—among other things it helps regulate the heartbeat and blood volume and is necessary for proper nerve function—too much can age us in a number of ways. A high-sodium diet contributes to high blood pressure in many people, and high blood pressure is the cause of 62 percent of stroke cases and 49 percent of heart disease cases (it also contributes to kidney disease and stomach cancer). Health organizations have been recommending that Americans cap sodium levels at 2,300 mg daily and those with high blood pressure take in no more than 1,500 mg. But now that the majority of Americans have high blood pressure or are considered sodium-sensitive, recent government guidelines extend the 1,500 mg daily upper limit for people who are fifty-one or older, African Americans of any age, and people who have diabetes or chronic kidney disease. My meal plan tops out at 2,300 mg sodium per day; any lower is very difficult to attain if you eat out at all. If you need to drop down to 1,500, adjust the plan by using reduced-sodium bread and cheese and choosing the lowest-sodium foods you can find. You might also eliminate the little bit of salt in 20 Years Younger recipes.
YOUR STRATEGY: Buy the lowest sodium foods you can in every category. Do this by comparing food labels when you shop—pretty soon you’ll have a repertoire of staples and won’t have to be so vigilant. Because you never know how much sodium’s been added to restaurant food, assume the worst. On days that you eat out, make sure the meals you eat at home are very low in sodium (aim for no more than 400 mg).
To meet the 2,300 mg sodium limit, the menus beginning here are very light in salt; perhaps lighter than you’re used to. If you’re finding it a tough adjustment, take out the salt shaker and sprinkle just a few crystals on the food on your plate. This will give you a much stronger hit of saltiness than if you’d poured a lot more salt into the food as it was being prepared.
Sugar
Americans are eating way too much sugar, and not just white table sugar, but high-fructose corn syrup, honey, fruit juice sweetener, and maple, brown rice, and agave syrups, too. Much of this sugar is coming from sodas and other sugary drinks, which contain about 10 teaspoons of sugar per 12 ounces (and many people are buying 16-and 24-ounce servings). Here’s the problem with all that sugar: The nutritionally empty calories promote obesity, wreak havoc on the system of anyone whose blood sugar is even a little high, and cause the formation of age-promoting AGE compounds (see the following section).
YOUR STRATEGY: While the naturally occurring sugar found in fruits and milk is fine, limit added sugar (the stuff you sweeten your coffee with and the sugar found in sweet beverages, desserts, candy, and unexpected places such as salad dressing and barbecue sauce) to no more than 8 percent of your total calories. That’s 30 g of added sugar on a 1,500-calorie-per-day diet, 34 g on a 1,700-calorie diet, and 40 g on a 2,000-calorie diet. Glance at the sugar column on the nutrition label and see how quickly you can hit your limit. There are 33 g of sugar in a 12-ounce soda; 25 g in a roll of Life Savers. I’d skip sodas and sugary beverages completely—not only are they excessively high in sugar, but your body barely notices those calories because liquid calories don’t fill you up nearly as well as calories in solid food.
Unfortunately, nutrition labels don’t distinguish added sugar from naturally occurring, so you have to use the ingredient list to figure it out. If there’s no fruit or dairy in the ingredient list, then all or nearly all the sugar is added. For something like ice cream or flavored yogurt, it’s impossible to tell what percent of sugar is from the milk and what’s coming from added sugar, but figure it’s at least half and half.
ANTI-AGE-ING COOKING
The way you prepare a food affects its health properties. Add a little oil to a salad or lightly sauté vegetables in oil and you’ll absorb a lot more carotenoids because they tend to cling to fat particles. Steamed or microwaved vegetables tend to retain more vitamin C and other nutrients than fried or roasted; and the longer a vegetable is cooked, the fewer nutrients it retains.
Cooking meat, poultry, and fish at very high heat (frying, grilling, and broiling) creates heterocyclic amines (HCAs), which are known to promote cancer. Other carcinogens produced by grilling are polycyclic aromatic hydrocarbons (PAHs); they’re formed when fat drips out of the meat (as well as vegetables and even bread rubbed with oil) and comes back as smoke that is absorbed by the food.
Though nutrition experts have been sounding the alarm about HCAs and PAHs for years now, there’s another dangerous side effect to high-temperature cooking that’s just starting to show up on the radar: AGEs. Aptly named, these “advanced glycation end products” speed up the aging process. We form AGEs in our bodies as well as consume them; they’re contained in many foods. When AGEs hit a critical mass they can cause inflammation, clogged arteries, cataracts, wrinkles and sagging skin, and kidney and nervous system damage. AGEs are formed in the body when sugars, such as blood glucose, combine with amino acids, the building blocks of proteins and other substances. High blood sugar is a major trigger of AGE formation because it means there’s a lot more sugar available to combine with amino acids. “The higher your blood sugar, the more AGEs you’ll form,” says Jaime Uribarri, MD, professor of medicine, Mount Sinai School of Medicine in New York City. A nephrologist (kidney doctor), Dr. Uribarri has been researching the effects of AGEs on kidney disease.
While eating sugar doesn’t necessarily make you more susceptible to AGE damage (unless you gain so much weight from your sweet diet that you develop high blood sugar), certain foods that contain high levels of AGEs do. Fresh fruits and vegetables, bread, and grains are lowest in AGEs, while foods of animal origin, such as meat, poultry, fish, and cheese are highest, particularly when they’re cooked at high heat. “AGE levels rise when foods are cooked, and the higher the cooking temperature, the more AGEs produced,” says Dr. Uribarri. “Grilling, broiling, roasting, searing, and frying are the worst offenders.”
For instance, AGEs in beef go up ninefold when you broil it; twelvefold when stir-fried. But use a lower temperature cooking method such as microwaving or stewing, and AGE levels only triple. Sautéed tofu has six times the AGEs of raw, but boiled tofu has only 20 percent more. Potatoes, like most fruits and vegetables, are very low in AGEs to begin with, but turn them into french fries and levels spike a staggering eighty-nine-fold. So far, of all the foods Dr. Uribarri and his colleagues have analyzed, fried bacon is the worst offender. The runner-up is roasted chicken skin (another good reason, besides lowering the fat content of your meal, to remove the skin from poultry).
People who regularly consume a high AGE diet have significantly higher levels of AGEs in their blood. But when they’re placed on a low AGE diet, not only do blood levels of AGEs fall—by about 30 percent—but more important, so do markers of disease risk, such as inflammation and oxidative stress. The menus starting here are good examples of how to lower your intake of AGEs. Most of the meat, poultry, and fish are poached, steamed, or stewed. Many of those foods are marinated, too: Cooking with a sauce containing vinegar or lemon juice tends to reduce AGE formation during heating, another good way to reduce your risk.
HOW LOW CAN YOU GO: THE SCIENCE OF CALORIE RESTRICTION
One of the hottest topics among anti-aging researchers is calorie restriction, consuming an exceptionally low number of calories as a strategy for life extension. The 20 Years Younger Diet is not a calorie restriction diet along the same lines as those being researched right now (though it can help you lower your calorie intake enough to lose weight). But I thought you might be interested to know a little about it. It’s definitely a subject you’ll be hearing more about in the future.
The connection between calorie restriction and longevity was first made in the 1930s when studies showed that in mice, cutting calories by 30 to 50 percent but keeping their diet nutritious extended their life span by 50 percent. Calorie restriction has even been shown to double the life span of some insects. And now major research institutions such as the National Institute on Aging are investigating whether it will work on humans—and whether it’s even practical. Some people aren’t waiting for the results; the Calorie Restriction (CR) Society International, an organization devoted to the practice, has upwards of 4,000 members.
How It Works
Why would significantly restricting calories extend life—and even make you healthier? One reason is that it lowers body fat and, as you might remember from chapter 1, excess body fat is linked to inflammation and insulin resistance, among other harbingers of disease. Also, when you’re not getting quite enough calories, your body responds by slowing down its metabolism. In this context, it’s important to understand that “metabolism” doesn’t just refer to the rate at which your body burns calories. Metabolism also refers to other chemical reactions in your body, including cell division. When the metabolism slows, the body shifts its focus from cell growth and reproduction to repair and maintenance of tissues, which slows down the aging process.
Calorie restriction has been found to slow down both “primary aging,” the damage done to cells from things like free radicals, and “secondary aging,” the development of diseases such as cancer, says Pennington Biomedical Research Center’s Donald Williamson, PhD. Pennington is one of the three research centers in the country carrying out the largest human calorie restriction study. It’s called CALERIE and is funded by the National Institute on Aging. When researchers measure cellular biomarkers of aging (such as telomere length and responsiveness of the immune system) in calorie-deprived rats, 90 percent of the biomarkers stay at youthful levels. Calorie-restricted rats and mice also postpone, or don’t ever get, cancer and diabetes.
In animal studies, calorie restriction starts in what’s roughly the equivalent of the late teenage years in humans. “Based on this research, the ideal age to start calorie restriction would be age twenty,” says Dr. Williamson. “But there’s some evidence—still iffy—that it could do you some good starting later, at age forty or even fifty.” The difference would be that you’d likely get secondary aging benefits—that is, a lower risk of life-threatening disease—rather than much deterrence of primary aging.
Is It Worth It?
I was once talking to a friend about calorie restriction when he said, “I’m not sure if it helps you live longer or it just feels that way.” I get his point. It’s hard to live on such a low-calorie diet. What’s more, it will take decades to know whether calorie restriction can extend human life without harmful effects because studies such as CALERIE are only just getting started. But we may have some clues because diet surveys were conducted in Okinawa beginning in 1949 and repeated at various intervals afterward. “Based on the surveys, it looks like the older generation in Okinawa has been taking in fewer calories than needed since they were in their twenties,” says Okinawa International University’s Dr. Willcox. Perhaps that’s one reason why the Okinawans, who’ve stayed slender all their lives, have managed to live so long. It’s also interesting to note that when researchers tested the blood of Okinawans in their seventies to measure the hormone DHEA, their levels were significantly higher than those of Americans of the same age. Because DHEA is known to diminish with age, higher levels are indicative of a more youthful biology. (Calorie-restricted animals also have higher DHEA levels.)
The CALERIE studies are already showing that calorie restriction reduces—no surprise—obesity, and that it also lowers inflammation and insulin sensitivity. It improves a number of other heart disease risk factors as well: LDL cholesterol, blood pressure, and heart rate go down, and the blood becomes less likely to clot. But doesn’t plain old diet and exercise accomplish all this? Yes, but based on animal studies, a calorie restriction diet is poised to do more. One reason is that calorie restriction isn’t just any old weight-loss diet; it’s an incredibly nutritious one, in which every bite (and you don’t get many!) counts. High levels of vitamins, minerals, and phytonutrients work in tandem with the slowing of the metabolism to stave off aging as long as possible. Another way calorie restriction differs from a typical weight-loss diet is that even after you lose excess weight, you continue restricting—for life—taking in about 20 to 25 percent less than your daily energy needs before you began the calorie restriction. (So if you maintained your weight at 2,000 calories before you started restricting calories, then you’d still eat 20 to 25 percent less—1,500 to 1,600 calories per day—even after you’ve lost weight.)
Now here’s where, to my exercise physiologist mind, it gets complicated. Calorie restriction’s anti-aging effects hinge largely on slowing down metabolism. Exercise does just the opposite; it speeds it up. Dr. Williamson, though, puts it in perspective. “Exercise does play an important anti-aging role. It helps you maintain the fat loss you’ve achieved through calorie restriction; that’s critical because excess body fat hastens aging. And exercise has its own effects on aging, such as reducing inflammation and reducing chronic disease risk,” he says. “But based on lab animal research, exercise alone doesn’t extend life; you have to add caloric restriction to the mix to get the deep cuts in primary aging.”
The big question is, how low into calorie restriction can most people go? If you’re eating 2,000 calories a day now, a 20 to 25 percent restriction will translate into about 400 to 500 fewer calories a day (a level you can meet by following the lowest calorie plan on the 20 Years Younger Diet). You don’t have to become rail thin to reap benefits, and no one should dip below a body mass index (BMI) of 18.5. (BMI is a measure of weight in relation to height. Calculate yours at 20YearsYounger.com.) And there are some other caveats, says Dr. Williamson. Calorie restriction isn’t for anyone younger than age twenty (it might interfere with growth and development) or older than sixty-five, because of the risk of losing muscle and bone along with body fat. Plus, there’s evidence that carrying a little more weight is protective in your older years.
We have a lot to learn before we can make any practical recommendations about calorie restriction. Until we get more information, it’s best to stick with what we know: a healthy diet coupled with a vigorous exercise regimen can go a long way toward increasing your life span.
While research into calorie restriction is in its preliminary stages, we have an abundance of evidence on the benefits of dietary supplements. Coauthor Diane McKay is a leading expert in the subject; you’ll hear from her next. She helped develop the formulations for my Bestlife supplements.
A REASONABLE APPROACH TO SUPPLEMENTS
By Diane L. McKay, PhD
When Bob Greene contacted me to help design a line of supplements, I was happy to hear he was committed to sticking with the science and producing a responsible line of supplements. What also sold me on the project is that, like me, he firmly believes that the ideal way to get your vitamins and minerals is through a nutritious diet. However, there is a place for supplements—as insurance, to help fill the gaps on days you don’t meet all your nutrient needs. Supplements are a lifesaver for many when it comes to those few nutrients needed in levels above and beyond what even a healthful diet can provide (like calcium, vitamin D, and, for some, vitamin B12).
The 20 Years Younger Diet is a highly nutritious diet, one designed to bolster your intake of fruits, vegetables, and whole grains, the foods so many people neglect. Without adequate intake of these foods, you’re certain to miss out on some of the nutrients you need to keep aging at bay. But even if you’re bucking the trend and actually eating a healthful diet, there’s still a case to be made for taking supplements for all of the reasons I stated above.
Someday, your doctor or nutritionist will be able to tailor a supplement to your individual needs based on your genes. But until the science of nutrigenomics (also called nutritional genomics) yields more definitive clues, there are some general recommendations you can follow. I recommend certain supplements in moderate doses, not exceeding the levels suggested by the Institute of Medicine (IOM), the organization that creates the recommended dietary allowances (RDAs). In most cases, the research does not support a need for higher levels of any one vitamin or mineral, and high doses of some can even be harmful. For instance, you can quickly reach toxic levels of vitamin A (retinol) and certain trace minerals like zinc with indiscriminate use of high-dose or megadose dietary supplements.
Again, aim to get all nutrients first and foremost from a healthful diet. Supplements aren’t a substitute for healthy eating. However, a multi can often provide some insurance, especially at certain stages in your life. Some nutrients also require special consideration. I’ll discuss them here, too.
Multivitamin and Mineral Supplement
While a multivitamin and mineral supplement may help seal up most of the cracks in your diet, it doesn’t cover you on phytonutrients, nor does it provide fiber—these you best get from food. It’s especially important to take a multi if you’re eating fewer than 1,500 calories daily, you’re a vegan or vegetarian, you’re highly athletic, or you have had gastric bypass.
Research showing the connection between longevity and multis isn’t definitive, but it’s suggestive. For instance, a Washington State University survey of about 78,000 middle-aged people found that those who took a multi for ten years had a 16 percent lower risk of developing heart disease. However, it’s tough to get a read on whether or not multis help stave off age-related diseases or slow the aging process because people who take multis tend to have healthier diets as well. Is it the multi or the diet? Probably a combination of both. When you shop for a multivitamin and mineral supplement, opt for one in which the daily values (DV) of each nutrient are around 100 percent except for those noted below, as well as calcium and magnesium. (The reason multis don’t offer more calcium is that the pill would simply be too big to swallow.) Instead of listing all of the recommended levels for each age and gender group on dietary supplement labels, manufacturers use the term DV.
YOUR SUPPLEMENT STRATEGY: Consider taking a standard multivitamin and mineral tablet daily. Here are some tips for finding the right one:
Look for multivitamins that are formulated at around 100 percent DV for most of the nutrients listed. Some nutrients may be listed at higher than 100 percent—B1, B2, and B12 are a few examples—but that is okay since they are not toxic at these levels.
Make sure they have at least 100 percent DV for vitamin D, and for women under 50 years old, 100 percent DV for folic acid.
Avoid multis with more than 100 percent DV for vitamin A, zinc, and, if you’re a woman over 50 or a man of any age, iron.
Don’t be lured by added herbs. There is no evidence that multis with added herbs provide any additional benefits, and they’re often a waste of money. Most herbs don’t provide any appreciable nutrients, and are present in low quantities or quantities below what might be considered beneficial. Some might also interfere with the absorption of certain nutrients.
For men, look for a formula with no more than 8 mg iron. For women under 50, look for a formula with at least 18 mg iron. After menopause, a woman’s need for iron drops back down to 8 mg, the same amount recommended for men. (This is the primary difference between multi formulas for men versus women, and younger versus older adults.)
Vitamin D
The vitamin D deficiency in this country had been called a “silent epidemic.” About 77 percent of Americans have low levels of vitamin D in their blood, according to a government survey. That’s worrisome considering how critical D is for building and maintaining bone; helping to prevent cancer, heart disease, and diabetes; and improving immune function. You don’t want to be low in D: This is one nutrient with a clear case for supplementation.
Vitamin D is formed when sunlight hits the skin, but if you’re not out in the sun much, or use sunscreen or clothing to thwart UV rays (as you should—see here), it’s easy to fall short. This is especially true if you have dark skin. Melanin protects the skin from the sun, but it also inhibits the skin’s ability to synthesize vitamin D. (Light skin, on the other hand, synthesizes D with little exposure, which makes sense on an evolutionary level since lighter-skinned people traditionally lived in the north where light was scarcer.) People who are obese are particularly susceptible to low levels of D, as are older adults who often don’t convert sunlight into D efficiently. Because the sun is weaker in winter, it’s also possible to have a deficiency during the colder months, especially if you live in northern latitudes (above Denver, St. Louis, San Francisco, or Washington, D.C.)
And you’re not going to find much vitamin D occurring naturally in foods. It’s in a few types of fish and mushrooms that have been exposed to light (as mentioned earlier, mushrooms purposely grown to be high in vitamin D have begun hitting the market), but otherwise, the D in your diet has to come from fortified milk, or dairy products made with fortified milk (don’t assume there is vitamin D in all yogurts and cheeses), some cereals, and spreads made without partially hydrogenated fats (like Bestlife buttery spread and spray).
Studies show that fortified foods do a good job of helping many people meet recommended levels for vitamin D, though scientists are now trying to determine if supplementing with D can give you a disease-prevention edge. One Canadian study of about 6,500 women found that those supplementing with more than 400 IU of vitamin D daily cut their risk of developing breast cancer by 25 percent. Other studies have shown that vitamin D supplementation may help lower the risk of colon cancer, prostate cancer, and even death from any cause. Supplementing with both D and calcium—but not D alone—appears to reduce the risk of bone fractures.
YOUR SUPPLEMENT STRATEGY: Get a blood test to determine your vitamin D level. If you’re deficient or have a low level, follow your doctor’s recommendation—that might be a high dose (prescription level) of D for a few months to get blood levels back up. Once you’re back to a normal level, or if you are already at normal levels, make sure you get a minimum of 600 IU from all sources (supplements and fortified foods, and the few foods containing D) if you’re an adult age seventy or younger; 800 IU if you’re seventy-one or older. This is consistent with the current IOM recommendation; however, some researchers think it may not be high enough. (Look for reports on vitamin D news as well as updates on all facets of anti-aging nutrition on www.20YearsYounger.com.)
Your multi should give you at least 600 IU (800 IU if you’re over age seventy). Try to get much of your D from foods first, and the rest through a vitamin D supplement. If you choose a supplement, look to see that it contains vitamin D3, which is used more efficiently by the body than D2.
Calcium
Besides its critical role in building and maintaining bone—especially important as you age and bone turnover slows down—calcium also helps regulate muscle contractions (including contraction of the heart) and blood pressure. Some evidence suggests that calcium protects against colon cancer, too. Calcium works in tandem with vitamin D to assist certain functions in the body, and you need to consume them together in order to absorb the calcium. So, take your calcium supplement at the same time as your multi, or, if you need extra D, take a combined calcium/D supplement.
Given that adults need a lot of calcium—1,000 mg calcium up to age fifty, then 1,200 mg for women over age fifty and men over age seventy—and most Americans aren’t meeting this requirement, taking a supplement is a good idea for many people. You can also meet the requirement with a combination of supplementation and food. The 20 Years Younger meal plan in Part II manages to pack 1,000 mg of calcium into most day’s menus, so getting adequate calcium through food is doable. Still, it’s not all that easy, especially when you’re keeping a lid on calories.
Although bone density peaks in young adulthood it’s important to get adequate amounts of calcium and vitamin D throughout your life to keep your bones healthy. In five separate studies in which elderly people took 700 to 800 IU of vitamin D and about 1,000 mg of calcium per day, hip fractures fell by about 24 percent.
YOUR SUPPLEMENT STRATEGY: Women age fifty or younger and men age seventy or younger need 1,000 mg calcium daily. Meet your needs with food first, then add a supplement. To get 1,000 mg through food, try this mix:
Consume two cups of nonfat or 1% milk, calcium-fortified soy milk, and/or 1–1½ cups nonfat or low-fat plain yogurt daily (that supplies 600 to 700 mg calcium).
Eat a wide variety of nutritious foods, a la our meal plan, which contributes another 300 mg calcium.
If you aren’t making the entire 1,000 mg through food, I recommend a calcium carbonate supplement (check the label—it will tell you the source of the product’s calcium) taken with vitamin D or a combined calcium/D tablet. Take no more than 500 mg of calcium at one time. A good strategy: take one tablet in the a.m. and the other in the p.m.
If you’re a woman age fifty-one or older or a man over the age of seventy and getting calcium through food as outlined above, you’ll need to add another cup of milk, calcium-fortified soy milk and/or plain yogurt or take a 300-to-500-mg calcium supplement. Also, after age fifty it’s a good idea to switch from using a calcium carbonate–based supplement to one made from calcium citrate. As you age, the level of acid in your stomach drops, and in that environment calcium citrate is better absorbed.
Vitamin B12
B12 and another B vitamin, folate (also called folic acid), are essential for properly functioning DNA and for the creation of certain proteins. Anything that influences DNA influences aging, so getting enough of this vitamin is critical, particularly because a severe deficiency can cause permanent neurological damage to your limbs and brain, and even dementia. Vegans and vegetarians are at risk because B12 is found only in animal foods, though you can find it in certain fortified breakfast cereals and soy milks. Consider a supplement if you don’t eat meat or eggs. The risk of a B12 deficiency goes up in all people after the age of fifty. About 10 to 30 percent of people over the age of fifty have atrophic gastritis, low stomach acid secretion, and stomach acid is required to properly absorb B12.
In gauging your B12 intake, it’s also important to consider how much folic acid you’re getting in your diet (the recommended amount is 400 mcg for men and nonpregnant women). Folic acid can affect the blood in a way that makes it difficult for a doctor to tell if you have a B12 deficiency. If you’re supplementing with folic acid (many women hoping to get pregnant do), you need to supplement with B12 as well, no matter what your age. If you take a multi, then you’re covered—a good multi like the type we recommend here will cover you for both. Be aware that if you’re eating a lot of foods that are fortified with folic acid, you may be tipping the balance and getting a lot more folic acid than B12. It’s possible that you may not even be aware that you’re eating folic acid–enriched foods. In 1996, in an effort to make sure pregnant women got enough folic acid (it prevents neural tube birth defects), the FDA published regulations requiring the addition of folic acid to enriched breads, cereals, flours, cornmeals, pastas, rice, and other grain products. Thus, many carbohydrates that you may eat on a regular basis contain added folic acid. However, whole grain versions usually aren’t fortified—another reason to switch to whole grains.
YOUR SUPPLEMENT STRATEGY: The RDA for B12 for adults is 2.4 mcg daily. Most multis provide more—about 6 mcg. That’s the amount you should be getting if you’re age fifty or younger to help counter all the folic acid that’s been added to foods. If you’re over fifty, you might consider taking a multi providing 50 mcg B12 (or a vitamin B12 supplement with at least 50 mcg). It’s a safe dose, and it helps ensure that you’re getting enough if you’ve been diagnosed with atrophic gastritis. If you take a separate B12 supplement, either an oral or a sublingual supplement will work.
Supplement Safety
While certain types of supplements may be helpful, there are some circumstances when supplements can actually be harmful. Here’s what you should know before you shop.
If you’re prone to kidney stones, be careful with calcium. Ask your doctor before taking calcium and vitamin D supplements. Most kidney stones are a mix of calcium and oxalates—compounds found in a variety of plants such as tea and whole grains. For people prone to kidney stones, taking in too much calcium can trigger stone formation. Yet even if you have a tendency to develop kidney stones, you still need to get adequate calcium. Some studies show that supplementing with calcium may actually protect against forming stones but only when the supplements are taken with a meal. This strategy reduces the likelihood of kidney stone formation because you absorb more calcium when you consume it with food. Take them outside of a meal and more winds up in the kidneys, where there’s a greater likelihood of the calcium binding with oxalates and forming stones.
In addition to taking calcium supplements with a meal, spread out your dose through the day, taking no more than 500 mg calcium at a time as noted earlier; that should prevent any problems. We also know that consuming plenty of fluids is one of the best ways to reduce your risk of kidney stones. Reducing your sodium intake might also be helpful because sodium in high amounts (the amount typically consumed by most Americans) can leech calcium out of your bones and the calcium eventually ends up in your kidneys.
Since vitamin D helps your body absorb calcium, high doses may impair kidney function by causing too much calcium to be absorbed. But it takes a lot of vitamin D—50,000 IU daily—to cause this problem.
If you’ve been diagnosed with precancerous colon polyps, cap folic acid at 400 mcg per day or less. Some research indicates that supplementation may actually spur polyps to become cancerous. Though folic acid is generally protective against cancer because it helps repair DNA and promotes growth of healthy cells, in excess, that same mechanism might trigger the growth of any cancer cells lurking. The research is still very preliminary, so it’s unclear at what point in your life you should avoid excess folic acid, and how much is too much if you have polyps (what we do know is that the upper limit for everybody is 1,000 mcg per day).
Because most multis offer 100 percent of the daily value for folic acid, consider taking it every other day if you are also consuming a lot of fortified foods. Missing out on all the other vitamins and minerals a multi provides every other day shouldn’t pose a problem for you if you’re consuming a healthy diet. The only exception is vitamin D, and for that I recommend taking a separate supplement. Before you decide to switch to taking a multi every other day instead of daily, check labels to find out which foods in your diet are fortified with folic acid, particularly labels of cereals, breads, and energy bars. (See here for more on preventing folic acid overload.)
Even if you haven’t any reason to think you’ve got precancerous polyps in the colon, sticking to no more than 400 mcg of folic acid daily is probably wise, especially if you are over age fifty. As noted earlier, another reason to avoid high doses at that age is that too much folic acid can cover up a vitamin B12 deficiency, to which people over age fifty are prone. Meanwhile, continue to eat foods naturally high in folate such as oranges and spinach—all the evidence points to naturally occurring folate as being protective. If you are under age fifty and plan to become pregnant, or if you are currently pregnant, you need to supplement with at least 400 mcg of folic acid daily. This is essential for helping to prevent a neural tube defect in your child and trumps concerns about colon cancer.
Avoid supplementing with beta-carotene beyond levels in a standard multi. Beta-carotene is an antioxidant plant pigment that gives plant foods such as carrots and cantaloupe their orange color and is also found in dark green vegetables. Your body converts beta-carotene, alpha-carotene, and a few other carotenoids to vitamin A as needed. Numerous studies show that people with high levels of beta-carotene in their diet and in their blood have a lower risk of cancer, so researchers figured that supplementing with it might help ward off the disease.
That’s when they got a big surprise. In two large studies, beta-carotene supplements were given to smokers and asbestos workers, the people most prone to lung cancer. Instead of offering protection as hoped, the beta-carotene supplementation increased the incidence of lung cancer and death. As for other cancers—such as pancreatic, breast, and prostate—the beta-carotene had no effect.
Fruits and vegetables that contain beta-carotene are also infused with other carotenoids and nutrients that work synergistically with one another to promote health. Removing beta-carotene from the food and delivering it alone in pill form does not have the same effect as consuming it in foods.
The take-home: Getting beta-carotene through food is important. However, while moderate levels of beta-carotene in your multi are safe (3 to 6 mg of beta-carotene daily, the equivalent of 833 IU to 1,667 IU vitamin A is fine) and probably helpful, don’t take separate beta-carotene supplements. A typical multi splits up vitamin A between beta-carotene and straight-out vitamin A (retinol). Check the back of the bottle—ideally, the multi should contain no more than 4,000 IU of vitamin A total, with no more than 50 percent beta-carotene.
Avoid supplementing with vitamin E in amounts greater than 200 IU. Vitamin E, like beta-carotene, looked so promising as a safeguard against cancer and heart disease. It’s also a powerful antioxidant. Some studies have shown that E from food and supplement sources may improve your chances of staving off heart disease. But in 2005, a review of the research found that in nine out of eleven major studies in which people took 400 IU or more of vitamin E from supplements alone, not only was it not protective, but it seemed to actually increase the risk of heart failure, gastrointestinal cancer, and dying from any cause—the more vitamin E, the higher the risk. Other research has confirmed the results and even shown that E supplements may slightly increase the risk of stroke. How to make sense of it all? It may be that the study subjects were taking too much vitamin E. Or too little: In one study, most of the deaths occurred in “noncompliant” people who didn’t actually take their vitamin E tablet as they were supposed to.
And there are still studies showing that vitamin E may improve your chances of staving off heart disease. For instance, in the Harvard’s Women’s Health Trial, which had 20,000 women taking 600 IU of vitamin E or a placebo every other day for ten years, there was a 24 percent drop in deaths from heart disease in women over age sixty-five taking vitamin E as compared to those taking the placebo (for younger women, there was no effect). While it’s safe to take as much as 400 IU of vitamin E daily, the evidence suggests that a lower amount, about 200 IU, may be more beneficial. Most multis only have about 30 IU, so a separate supplement might be appropriate (especially if your diet is lacking). Buy the natural form (d-alpha-tocopherol) and take it with a meal; otherwise it may not get absorbed into your system. If you find that it’s nearly as expensive to buy 200 IU tablets as 400 IU, then buy the latter and take a pill every other day.
Because supplements are sold over the counter, it’s easy to assume that they are all safe and beneficial. Not necessarily so. To sum up, here is what you should keep in mind when you shop.
Multivitamin and mineral supplements can be helpful, but make sure that you purchase one that is well balanced.
Never megadose—that is, take double or triple (or more) of the levels recommended by the Institute of Medicine—even if you’ve read that a vitamin or mineral has no known toxicity.
If you have any type of health condition, always discuss supplementation with your doctor before stocking up.
Always bring a list of supplements you are taking with you when you see your doctor. Some supplements can interfere with certain drugs, and your doctor needs to know what you’re taking when prescribing medications for you—or even when diagnosing your condition.