It won’t come as a surprise by now that the biggest enemy in people’s diet is inflammation. Medical researchers have tracked its footprints all over the map, from chronic disease and obesity to leaky gut syndrome and mental illness. The typical American diet is very likely to increase inflammation, and therefore a change is called for. The change will be drastic for anyone who subsists on junk and fast food. Yet the overload of sugar that enters into almost any diet if you aren’t vigilant is also a prime suspect. Evolution didn’t prepare us to consume over one hundred pounds of refined white sugar a year; it’s not clear we evolved to consume it at all, along with the cheaper corn syrup that manufactured foods increasingly contain.
Inflammation is necessary to the healing process, when the immune system rushes chemicals known as free radicals to flood the wounded or diseased area. Almost all the symptoms of flu, such as fever and aches and pains, are not from the flu virus but from your body’s recovery efforts and the inflammation that comes along with it. In this way, inflammation is our friend. Yet our friend can turn on us without our being aware.
You can be in a state of chronic inflammation without knowing it, because unlike the red, swollen areas that appear on your skin when it’s inflamed, the internal signs of inflammation often go unnoticed. There is typically no feeling attached when the immune system is mildly compromised, and some signs of inflammation, such as joint pain, could have other causes. Our approach is to make easy choices that have an anti-inflammatory effect. An anti-inflammatory diet will cause most people to notice benefits right away.
Reading the menu: The menu of choices is divided into three parts, according to level of difficulty and proven effectiveness.
First are the choices that anyone can implement. If you begin to adopt them, you will be laying the foundation of your pyramid. As tempting as it is to adopt more than one easy choice at a time, resist the urge. Over the course of a year, you will be making fifty-two weekly changes in your lifestyle. There’s no need to pile up on yourself.
These are choices that you feel resistance about adopting, or which you know are too difficult to maintain without backsliding. That’s perfectly okay. Harder choices can wait until you feel you have made all the easy choices you can. For some people the harder choices will actually be easy, because everyone has a different starting point. For most people, however, the harder choices are for higher up on the pyramid. They need to feel easy before you tackle them; otherwise you risk making a change that you can’t continue.
These are steps that have strong advocacy and intriguing research behind them, but which definitely constitute a minority position for now. Dietary fads come and go. Today’s research gets modified or overturned tomorrow. Before adopting an experimental choice, read our caveats, pursue your own investigations, and make an informed choice. In any case, none of these experimental choices should substitute for the choices in Parts 1 and 2.
Remember that whatever choices you make are meant to be permanent. Since you are making only one change a week, you have seven days to see how it works out. If everything goes smoothly, you’re ready to select a second change in the following week. Don’t rush; don’t put pressure on yourself. The secret to this strategy is making sure that it progresses effortlessly.
We think it’s prudent to make dietary changes first, because food has the most direct effect on the microbiome. Our advice is to spend the first month entirely on dietary changes, but it’s up to you. Before making any change, be sure that you’ve read all six sections of the program.
• Add prebiotics with soluble fiber to your breakfast (e.g., oatmeal, pulpy orange juice, bran cereal, bananas, a fruit smoothie made from unpeeled fruits).
• Eat a side salad with lunch or dinner (preferably both).
• Add anti-inflammatory foods to your diet (see this page).
• Consume probiotic foods once a day (e.g., active yogurt, kefir, pickles, sauerkraut, kimchi).
• Switch to whole-grain bread and cereals.
• Eat fatty fish at least twice a week (e.g., fresh salmon, mackerel, tuna, and canned or fresh sardines).
• Reduce alcohol to one beer or glass of wine a day, taken with a meal.
• Take a daily probiotic supplement and a multivitamin pill. Also take half an adult aspirin or one baby aspirin—see this page.
• Reduce snacking by eating only one measured portion in a bowl—don’t eat from the bag.
• Share dessert in a restaurant.
• Switch to organic foods, including chicken and meat from animals not raised on hormones.
• Limit or eliminate red meat from your diet; at least switch to organic alternatives, including chicken and meat from animals not raised on hormones.
• Switch to “pastured” eggs high in omega-3 fatty acids (see this page).
• Become a vegetarian.
• Cut out refined white sugar.
• Drastically reduce packaged foods.
• Eliminate alcohol.
• Stop eating fast foods.
• Stop buying processed foods.
• Stop eating when you’re not hungry.
• Adopt a gluten-free diet.
• Become a vegan.
• Eliminate wheat entirely.
• Have only fruit and/or cheese instead of dessert.
• Adopt a Mediterranean diet (see this page).
We won’t need to explain every choice on the list individually, because there’s a shared goal behind everything: fighting inflammation. In the easy category, your goal is to find effortless ways to combat inflammation. Chief among these is resetting your microbiome, where the digestive process starts the pathway that leads to inflammation. As we saw earlier, toxins produced by your gut microbes are safe as long as they remain in the digestive tract. But “leaky gut syndrome,” which seems to be much more prevalent than previously expected, sends toxins into the bloodstream, and from there, the body fights the toxins using inflammation—a healthy response, but a dangerous one. Resetting your microbiome is the best defense and the first step to keeping these toxins where they naturally belong.
Modern life exposes us to many influences that either harm the microbiome or are suspected to harm it, including the widespread use of antibiotics, a high-fat, high-sugar diet, lack of fiber, air pollution, excessive stress, bad sleep, and various additives and hormones in the food we buy. The microbes that colonize the gut are a direct cause of inflammation but also a protection against it when the microbiome is healthy.
You aren’t aiming for a “perfect” microbiome, because no one can define such a thing, not yet at least. With over one thousand species of bacteria to consider, and with the microbiome being in a constant state of flux, perfection may be unattainable, or even the wrong thing to pursue. It’s easier and more sensible to change your diet away from inflammation. There’s no harm in doing so, and doing so offers the promise of many benefits.
Prebiotics come first. These are foods for the microbiome, chiefly from fiber that our own bodies can’t digest. Evolution has led to a happy partnership in which bacteria consume the fuel they need without robbing our bodies of any, and vice versa. Prebiotic foods also buffer the body from inflammation by reducing endotoxin, a poison created by certain bacteria that is harmless inside the GI tract but highly inflammatory if it leaks into the bloodstream and activates the immune system. (See this page regarding the research that shows how a glass of freshly squeezed orange juice completely offsets the inflammatory effect of a high-fat McDonald’s breakfast.)
Prebiotic foods aren’t scarce. We recommend a breakfast that’s rich in them, from bananas and pulpy orange juice to oatmeal, whole-grain breakfast cereal, and fruit smoothies made with unpeeled apple, various berries, and other fruits. You’ll find countless recipes online, and the smoothie can be made with vegetables instead of fruit if that’s what you prefer. Just be aware that green vegetables, the main ingredient in veggie smoothies, are much lower in calories than fruit. You don’t want to eat a breakfast that’s lower than 350 to 500 calories if you want enough energy to get to lunch without hunger pains and with sufficient energy. A salad with lunch or dinner also serves as a good prebiotic buffer.
Probiotics are foods that contain active bacteria. Active yogurt is the most common one at the supermarket, but there’s also pickles, sauerkraut, kimchi (a traditional Korean fermented cabbage dish), and kefir (a fermented milk drink that tastes similar to yogurt). Including one of these foods during a meal helps to reset your microbiome by introducing beneficial bacteria that will colonize the walls of the intestine and hopefully reduce or drive out harmful bacteria. Because of the complexity of the microbiome and the huge differences from one person to another, there is no completely reliable prediction on the effects of probiotic foods. The best thing is to try them—all are completely harmless—and then look for results.
Probiotic supplements are a booming business that’s expected to rise dramatically in the future. Health food stores offer a bewildering variety of these supplements, some in pill form to be taken on a full stomach, others in perishable form that must be refrigerated. There is no expert medical advice about the best probiotic supplements, for the same reason that crops up repeatedly: the microbiome is too complex and is constantly shifting. It should also be noted that a reliable supplement that contains 1 billion bacteria will enter a gut ecology of 100 trillion microbes. Outnumbered 100,000 to 1, the supplement may have negligible impact.
We prefer to be optimistic. Any opportunity to reset the microbiome to a state of natural balance is worth taking. A supplement can’t substitute in any significant way for getting your probiotics through food, yet it’s an easy choice to take a supplement. Also, to augment the benefit, add a multivitamin and one baby aspirin, or half an adult aspirin, to your routine. The aspirin is a proven way to reduce the risk of heart attack and some kinds of cancer. (Be sure to consult your doctor before combining aspirin with other drugs, particularly those that have anti-inflammatory or blood-thinning properties.) The multivitamin isn’t a must if you are eating a balanced diet, but as we age, the intestinal tract becomes less efficient at processing vitamins and minerals. Studies have shown that up to one-third of dementia cases are linked to mineral deficiencies or poor diet.
Dementia is a generic term that covers a host of disease conditions, including Alzheimer’s disease, which Rudy studies, and there’s no accepted dietary regimen that is guaranteed to be preventive. But research that focuses on how food affects brain cells has come up with a few general guidelines that are easy to follow; most are directly in line with an anti-inflammation diet. The preventives are
Omega-3 fatty acids found in fatty fish (For those who are alarmed by heavy metals present in fish oil, an alternative source is organic flaxseed oil along with a handful of walnuts every day. If you do choose fish oil, use triple-distilled oil to avoid heavy-metal contaminants.)
Antioxidant micronutrients (blueberries, dark chocolate, green tea) to fight free-radical damage in the brain
B vitamins (not more than the recommended daily allowance)
A Mediterranean diet (see this page)
Keep in mind that these are provisional suggestions. Even a supplement like vitamin E, which has been promoted for decades for its antioxidant effects, has run into contrary research. The basic neuroscience revolves around the fact that brain tissue is quite vulnerable to free-radical damage, because the brain uses 20 percent of the total oxygen consumed by the body. Free radicals are molecules with an extra oxygen atom that is quick to find another molecule to bind with. Although necessary for healing wounds as part of the whole inflammatory response, free radicals in excess can damage healthy cells through unwanted chemical reactions; brain cells seem to be a prime target in cases of dementia.
Reducing potential damage from overly active oxygenation is the common link connecting most of the preventives listed above, but totally validated proof is lacking. Our position is that a balanced diet is the best way to protect yourself, but taking a supplement may be helpful, particularly if you are over age sixty-five. A common effect of aging is reduced kidney function, which often results from low-level inflammation of the kidneys, or nephritis. Decreased kidney function diminishes the body’s retention of the water-soluble vitamins B and C. Taking a multivitamin supplement, then, makes sense if you are older. The main drawback for most people is that vitamins don’t usually have any discernible benefit that you can feel, and the damage that can be traced to inflammation, including excess free radicals, should be addressed directly through an anti-inflammatory dietary regimen.
Anti-inflammatory foods have come into favor with increasing public interest and research studies. If you are primarily interested in seeing a list of specific anti-inflammatory foods, you can find a generally agreed-upon list at www.health.com. But it is much more effective to understand the whole issue of inflammation, because a holistic approach attacks the problem from many angles instead of just one. The following foods are listed primarily to reinforce your knowledge, not to tell you that only these “right” foods belong in your diet.
Fatty fish (but see the caveat about heavy metals on this page)
Berries
Tree nuts
Seeds
Whole grains
Dark leafy greens
Soy (including soy milk and tofu)
Tempeh
Mycoprotein (from mushrooms and other fungi)
Low-fat dairy products
Peppers (e.g., bell peppers, various chilies—the hot taste isn’t an indication of inflammatory effects in the body)
Tomatoes
Beets
Tart cherries
Ginger and turmeric
Garlic
Olive oil
In their online health publications, Harvard Medical School adds a few items to the list:
Cocoa and dark chocolate
Basil and many other herbs
Black pepper
Alcohol in moderation (but also see this page)
Other listings add the following:
Cruciferous vegetables (cabbage, bok choy, broccoli, cauliflower)
Avocado
Hot sauce
Curry powder
Carrots
Organic turkey breast (substitute for red meats)
Turnips
Zucchini
Cucumber
Needless to say, these are all healthy whole foods, and making them a mainstay of our diet can only be beneficial. However, the science is still out on whether all of these foods have an anti-inflammatory effect in the body, and also what effect, if any, they have on the genome, epigenome, and microbiome. Still, the fact that your super genome responds to every experience strongly suggests that what you eat has consequences at the genetic level. The fact that so many diseases are connected to bad diet proves that there’s a genetic connection, so our best advice is that a good diet is one way to promote better genetic activity.
On the opposite side, there are also foods that increase inflammation, as listed by the same bulletin from Harvard Medical School.
Red meat
Saturated and trans fats (e.g., animal fats and the hydrogenated vegetable fats found in many processed foods)
White bread
White rice
French fries
Sugary sodas
To these, other reliable sources add
White sugar and corn syrup (frequently hidden in processed foods that aren’t primarily sweet)
Omega-6 fatty acids (see this page)
Monosodium glutamate (MSG)
Gluten (see this page)
Our feeling is that an anti-inflammatory diet has to be better than an inflammatory one, because the foods that are proven risks—junk food, fast food, fatty and sugary foods—also lead to inflammation. The link between inflammation and chronic disease is too strong to ignore, and paying attention has many benefits.
The Mediterranean diet has a good reputation for being healthy. A 2014 study conducted in Spain made headlines by proving with statistical accuracy that subjects who ate a Mediterranean diet lowered their risk of heart attack considerably. In fact, the results were so positive that the study was cut short, since it became unethical to allow the other subjects to continue on their non-Mediterranean diet. There have been no similar studies of an anti-inflammation diet (in fact, the Spanish study was the first of its kind to be conducted with such scientific rigor), but the overlap is significant. A Mediterranean diet replaces red meat with fish, and butter with olive oil. Alternatively, for vegetarians like Rudy, noninflammatory protein can be obtained from other sources like tempeh, tofu, and mycoprotein (e.g., Quorn and Gardein products). Whole fruits, vegetables, low-fat tree nuts (e.g., almonds and walnuts), and seeds (e.g., chia, hemp, sunflower, pumpkin, flax) are also recommended. When you add all of these up, you’ll see that some of the most important anti-inflammation foods are there in the Mediterranean diet.
Why, then, do we place the Mediterranean diet under experimental choices? There are several reasons. First is the permanence of such a change. Sticking with the diet comes easily if you are a native of the region and have been on it since childhood, but the Mediterranean diet is not so easy as a lifetime choice if you are used to the typical Western diet. Also, unless you live alone, there’s the issue of asking your family to make the change with you. But just as important is the science. The kind of study that was conducted in Spain is about risks as they pertain to large groups. It’s a numbers game. Going on the Mediterranean diet doesn’t guarantee that any individual is protected, while our aim here, to fight inflammation, is completely about the individual. Still, the Mediterranean diet comes close to being an anti-inflammation diet, so it’s very worthwhile to try, but only after you’ve made other, easier choices to see if you’ve accomplished the same goal.
Switching to olive oil brings up the tangled issue of fats in the diet. Our primary advice is to avoid trans fats, chiefly hydrogenated oils found in packaged foods and at some, but not all, fast-food chains. These oils are known to have inflammatory effects. Limiting saturated fats in butter and cream and avoiding red meat also seem prudent.
You need to have a healthy balance of blood lipids (fats), including cholesterol and triglycerides. Both are necessary for cell building and repair. Blood lipids are processed by your liver after you ingest fat in your diet. This processing is quite complex, depending on diet, genes, weight, age, illness, and other factors. Problems can arise for anyone who is obese, whose liver is genetically predisposed to deliver too much cholesterol to the body, who suffers from a hormonal imbalance, or whose immune system has been activated by inflammation, among other factors. It’s not as simple as “ingest more cholesterol, and your cholesterol levels will go up.” To further cloud the issue, the leading drugs for lowering cholesterol, known as statins, do not seem to reduce the risk of heart attacks, according to studies going back to 2010. This indicates what has long been known, that heart attacks depend on more than just cholesterol.
We feel that inflammation, which is strongly linked to heart disease, is the first culprit to go after. The damage it causes can be traced back to the gut-inflammation connection. With so many risk factors tied to inflammation, it seems better and easier to work on it as a whole rather than singling out “good” and “bad” fats. We aren’t endorsing saturated fats by any means. Polyunsaturated cooking oil, and especially olive oil, remains the healthiest choice.
Another issue is how much fat you should be eating. People find it quite difficult to cut back their fat consumption all at once, even though extreme fat restriction has long been part of the heart health program devised by Dr. Dean Ornish at the University of California, San Francisco. Ornish’s lifestyle-driven approach to heart disease led to extraordinary results. His program of diet, exercise, meditation, and stress reduction remains the only proven way to reverse the plaque that lines the coronary arteries in people at high risk for heart attacks. Ornish also pioneered in studies showing that his program creates beneficial changes in the genome through epigenetic switching of hundreds, now thousands, of genes, a process known as upregulation.
To clear coronary arteries of plaque, as Ornish has accomplished, requires a severe cutback in fat intake, to as little as one tablespoon of added fat a day. The standard recommendation from the American Heart Association allows for fat to be 30 percent of one’s daily calorie intake—a huge difference. (Even reaching 30 percent is difficult, considering that the average American diet, although around 34 percent fat, which doesn’t seem far off the mark, has actually added an extra 340 calories a day over the past two decades. This amounts to a potential weight gain of over 30 pounds a year.)
We support and acknowledge Dr. Ornish for his invaluable work, but severe fat restriction leads to noncompliance. Cutting back to only a few tablespoons of all fats and oils a day, or as little as one tablespoon if you are being rigorous, simply taxes the average person too much. Low-fat diets for weight loss probably fail around 98 percent of the time, insofar as that’s the failure rate for all crash diets. Our approach of building a pyramid of easy choices doesn’t include severe fat restriction.
Besides noncompliance, we have another good reason, we believe, for not putting a strong emphasis on fats or on cutting back on calories as the road to weight loss. Animal studies strongly suggest that the microbiome may be the real key. As we alluded to earlier, simply by inserting microbes from obese mice into other mice with the same genome leads to weight gain in the normal mice. Anecdotal evidence from self-experimenters like Dr. Zhao in China leads to the same conclusion, as does the small study with identical twins in which one twin is obese and the other twin lean.
Resetting the microbiome through an anti-inflammation diet is win-win. It will either lead directly to weight loss or put you in a state of balance in which moderate calorie cutting becomes feasible without backsliding. We’ve summarized our weight-loss strategy in the following list.
• Don’t follow a calorie-restricted diet. Leave calorie cutting for the end, not the beginning, of your weight-loss regimen.
• Focus on the easy steps for reducing inflammation first.
• Put your attention on prebiotic and probiotic foods.
• At the same time, make easy choices about increasing your physical activity. The most important step is to stop being sedentary and to move throughout the day.
• Attend to good sleep, since bad sleep throws off the key hormones for hunger and satiation.
• Make easy choices relating to emotions, since emotional eating is generally a component of weight gain.
• After following the above steps for at least 3 to 4 months, assess if you are losing weight. A loss of ½ pound per week would be considered a high benchmark. A loss of 2 pounds a month is still a success. If you’ve lost that much, keep doing what you’re doing without cutting calories.
• If you see no weight loss, consider cutting 200 calories from your daily intake as long as that’s easy for you. Consider this a permanent choice like the other easy choices on the program.
• If it’s not easy to cut calories, keep making other changes and check back on your weight in 2 months. Reassess calorie cutting then.
Alcohol has had its medical proponents for a long time, and the public tends to accept that the French have lower heart attack rates because of the national habit of wine drinking. In the list of anti-inflammatory foods, the Harvard Medical School online site includes a drink a day (although not defined, this presumably means one beer or one glass of wine) because of a single beneficial effect: it seems to lower levels of C-reactive protein (CRP), a powerful signal of inflammation. More than one drink (the source of the alcohol doesn’t appear to matter) increases CRP, however. In general, alcohol has been classed as inflammatory. It is metabolized very quickly, like refined white sugar, and we consider it in the same class as white sugar when it comes to potential damage throughout the system.
But we are also realists and realize that social drinking is deeply embedded in the West and is increasingly catching on in Asia. People don’t like giving up something they enjoy. Therefore we offer an easy choice to limit yourself to one drink a day, preferably as part of a complete meal so that the metabolic rush of the alcohol is tempered by other food. Our hope is that by adopting easy changes that reset your microbiome and send positive messages to your epigenome and brain, you will no longer want to drink. You’ll feel good enough without it, and your sense of well-being will actually be lessened by not having any alcohol at all.
Reducing gluten in your diet also falls under the experimental heading. The number of people considered by mainstream medicine to suffer from a gluten allergy is tiny (the most common diagnosis is among those with celiac disease, which severely damages the intestines), but there’s a widespread belief, amounting to a crusade, that countless others are feeling the ill effects of gluten. As anyone soon discovers when trying to eliminate gluten from their diet, it appears in many processed foods, not just in the usual source that comes to mind, which is wheat and wheat products.
Symptoms of gluten sensitivity, often generalized as “wheat belly,” include bloating, diarrhea or constipation, distended abdomen, and abdominal pain. This list, which centers on digestion, has been extended by some advocates to other symptoms elsewhere in the body, such as headache, generalized pain, and fatigue. Self-diagnosis is the most common route, because doctors look for specific allergic responses recognized as celiac disease or the most typical alternative, nonceliac gluten sensitivity. Medical training also pinpoints various disorders, like irritable bowel syndrome, that have much the same range of symptoms; or wheat allergy, which is sometimes present without sensitivity to other sources of gluten.
Since we are asking you to make easy choices first and foremost, going on a totally gluten-free diet isn’t one of them. The list of foods you would have to give up is long (provided by www.healthline.com):
Bread, pasta, and baked goods made from wheat (or wheat bran, wheat germ, or wheat starch)
Couscous
Cracked wheat
Durum
Farina
Farro
Fu (common in Asian foods)
Gliadin
Graham flour
Kamut
Matzo
Semolina
Wheat isn’t the only grain that contains gluten, so you’d also need to cut out
Barley
Bulgur
Oats (oats themselves don’t contain gluten but are often processed in plants that produce gluten-containing grains and therefore may be contaminated)
Rye
Seitan
Triticale and mir (hybrids of wheat and rye)
Veggie burgers (if not specified gluten free)
Gluten may also show up as ingredients in barley malt, chicken broth, malt vinegar, some salad dressings, and soy sauce, as well as in many common seasonings and spice mixes. A gluten-free diet requires total dedication. For the sake of completeness, we’ll list the grains that are permitted on such a diet.
Amaranth
Arrowroot
Buckwheat
Cassava
Millet
Quinoa
Rice
Sorghum
Soy
Tapioca
Of course you also have the choice of limiting gluten-containing foods rather than eliminating them entirely. Both of us have been intrigued enough to try eliminating gluten in our own diets, and we are very enthusiastic about the results in increased energy, balanced appetite, and some weight loss. It should be realized, however, that the scientific validation remains to be seen for “wheat belly” as a widespread ill and for wheat sensitivity as a problem affecting millions of people.
If you are still intrigued, go ahead and try an experiment for a week. A simple diet of rice instead of wheat is the foundation for billions of Asians. You would also cut out pasta and the vast majority of baked goods. But this isn’t onerous now that gluten-free sweets are on the market, and you don’t need to resort to them if you have nonprocessed sweets like flan or bake with gluten-free flour. The results of our experiment are likely to be quite good, since an Asian diet minus pasta, bread, cake, pie, and cookies is already quite healthy, leaving aside the controversial issue of gluten sensitivity.
Vegetarian diets have long been considered a healthy alternative. We have made a personal choice to move toward a plant-based diet. Rudy has been vegetarian since his university days, but when faced with a busy schedule, he does consume some dairy for the purpose of quick protein. In India, the Brahmin, or priest, caste traditionally subsists on a meat-free diet, and for many people excluding meat is a humanitarian measure connected with the killing of animals. For most people, however, vegetarianism represents a hard choice. Being naturally high in fiber, a vegetarian diet is very likely to be anti-inflammatory and beneficial to the microbiome as well. Why, then, aren’t lifelong vegetarians free of chronic disease? Actually, many are. The current data show that vegetarians are at lower risk for
Heart disease
Colorectal, ovarian, and breast cancer
Diabetes
Obesity
Hypertension
These findings don’t sort out the anti-inflammation factor, so there’s no way of knowing the status of vegetarians who also avoid refined sugar, alcohol, high stress, and a sedentary lifestyle. Until there’s a study on people who have adopted a holistic lifestyle aimed at reducing inflammation, being a vegetarian stands as a very good choice if it’s easy for you, but it’s by no means a panacea.
On a comparative scale, it’s much easier to follow a vegetarian diet than a vegan diet. Like a vegetarian diet, a vegan diet is plant based and excludes meat, but it also typically excludes all dairy products (milk, cream, yogurt, butter, cheese), along with eggs and all products that contain these ingredients. A strict vegan diet therefore involves a meticulous regimen for getting adequate protein. Soy (in tofu or tempeh) is a complete protein and as such is generally a major source of protein for many vegans, and also for vegetarians.
Your body needs nine amino acids, the building blocks of protein, that it cannot produce itself. It’s not necessary to have all of them at every meal, and for vegetarians, a diverse mixture of vegetables, fruits, seeds, and nuts will be sufficient. However, there are some foods for vegetarians in addition to soy that contain all nine of these essential amino acids, including quinoa, buckwheat, hemp seed, chia, and the simple food combination of rice and beans.
Rudy limits his soy intake to one meal a week so as not to overload on phytoestrogens—naturally occurring compounds in soy that are similar to human estrogen. Although current research tends to show that males don’t suffer a risk of lower testosterone from phytoestrogens, Rudy has made this personal choice in terms of his intake of hormones.
Besides these protein sources, to make sure you’re getting adequate protein as a vegan you would use combinations of foods that contain various amino acids, the building blocks of protein, to get a full complement—that is, a complete protein. (The usual route is to combine legumes, grains, potatoes, and even mycoprotein, e.g., in Quorn products, in different combinations.) We have put vegetarianism under harder choices and vegan diet under experimental choices for the above reasons. Having been a vegetarian since college, Rudy, along with his entire family, fully enjoys this lifestyle choice.
Both the epigenome and the microbiome play crucial parts in how food affects your body at a much deeper level than was ever suspected. When nutritionist Victor Lindlahr titled his 1942 book You Are What You Eat, he did more than coin a popular phrase; he foresaw by decades the research that would support the diet-gene connection. Now numerous studies exist, primarily with mice, showing that diet is in fact the main factor influencing the composition of the microbial genome we harbor in our gut. For example, switching suddenly from a vegan to an animal-based diet changes the microbiome in just days. In a study at the University of California, San Francisco, mice were fed either a high-animal-fat, high-sugar (junk food) diet or a low-fat, plant-based (vegan) diet. When the animals were then switched from the vegan to the junk food diet, the host of intestinal microbes (as assessed in their feces) changed within three days regardless of the genetics of the mice used. Diet mattered much more than genes. This finding helps to explain why identical twins with identical genomes can have as many differences in their microbiome as two siblings who aren’t twins and therefore have similar but not identical genomes.
Diet also dramatically affects epigenetics, as we saw earlier in the example of the Dutch famine during World War II. In rural Gambia, for example, there is a rainy (hungry) season, when nutrition is low in protein and energy, and a dry (harvest) season, when the diet is heavy in vegetables and high-energy foods. Children of 84 mothers conceived during the hungry season had lower birth weights and higher levels of epigenetic modifications (methylation) in their genome than those conceived by 83 mothers during the harvest season. (There were also major differences in B vitamin and folic acid levels in maternal blood samples in the two seasons, which correlated with the epigenetic changes.)
The children born to mothers who experienced an unhealthy diet during conception were also more likely to go on to develop insulin resistance and type 2 diabetes. Naturally, these facts underscore the need for all pregnant women to maintain a healthy diet, but the larger point was expressed nearly two centuries ago when the noted French gastronome Jean Anthelme Brillat-Savarin wrote: “Dis-moi ce que tu manges, je te dirai ce que tu es”—“Tell me what you eat, and I will tell you what you are.”
When people look for information about diets, three forces pull at them. All three are supposedly based on science, yet they contradict one another.
First is the standard nutritional advice to eat a balanced diet. This advice changes slowly. It is well established in nutritional studies. The problem is that people don’t comply. In the face of solid science, the American diet continues to move in the wrong direction (i.e., high fat, high sugar, an overload of calories, reliance on junk and fast foods).
Second is cutting-edge research studies. These studies can be very intriguing, and the studies on inflammation and the diet represent a major breakthrough. The problem is lack of human trials on a wide basis, along with findings that contradict each other.
Third is the latest fad diet for weight loss. These diets typically make overstated claims and seem to change every day, using “breakthrough” research that may be flimsy or badly skewed. Sometimes no real science exists in support of the latest diet. Yet the public rushes to follow the latest fad until a new one is touted on the grapevine.
We’ve taken a stand on some cutting-edge research despite the absence of large-scale human trials. Countering inflammation, as with the Mediterranean diet, seems scientifically sound to us. In any event, an anti-inflammation diet overlaps with standard nutrition in almost every area and thus provides a second source of scientific validation. However, there are areas of confusion in an anti-inflammation diet that should be faced honestly.
Fatty acids are a prime example of such an area of confusion. There has been rising awareness that the omega-3 fatty acids found in fatty fish are good for you, and standard nutrition advises everyone to eat such fish once or twice a week. Yet there’s another group of fatty acids, omega-6s, that complicate the story. Your body needs both omega-3s and omega-6s, and because it can’t make them, they must come through diet. What makes these substances special is that unlike other fats, the omega group isn’t used primarily for energy, but for biological processes, including the production of red blood cells.
It seems to be crucial, according to various studies, to keep omega-6 levels down, because high levels are strongly linked to inflammation. Improvements in heart disease and rheumatoid arthritis have been shown by getting the balance between omega-3s and omega-6s back into the healthy range. All Western diets are too high in omega-6s because of the heavy use of polyunsaturated cooking oils. Yet these oils, made from vegetable sources—corn, soy, safflower, and so on—were once considered the healthiest ones, with risk factors for heart attack as the primary support for this claim.
Today the evidence has strongly moved in another direction. Studies of indigenous peoples (who use few processed vegetable oils and eat no processed packaged foods) indicate that the ratio of omega-6s to omega-3s in their diet is about 4:1. In contrast, Western diets are fifteen to forty times too high in omega-6 foods, with an average ratio of omega-6s to omega-3s of 16:1. At such high levels, the omega-6 fatty acids block the benefits of the omega-3s. Genetic studies aren’t easy to come by in this area, but it’s speculated that we evolved in hunter-gatherer societies to consume a diet even lower in omega-6s, with a ratio of omega-6s to omega-3s closer to 2:1. In the body, getting closer to a 1:1 ratio seems ideal, according to some experts.
Among foods high in omega-6s, cooking oil leads the way, but there are others, as follows:
Processed vegetable oils—highest are sunflower, corn, soy, and cottonseed
Processed foods using soy oil
Grain-fed beef
“Factory-raised” chicken and pork
Non-free-range eggs
Fatty cuts of conventionally raised meats
As you can see, the polyunsaturated oils that are a major part of standard disease prevention turn out to have a serious drawback in terms of inflammation. The only vegetable oil that is low in omega-6s and high in omega-3s is flaxseed oil. Safflower, canola, and olive oil aren’t particularly high in omega-3s but are the lowest in omega-6s among commonly sold vegetable oils, with olive oil the best.
Adding to the confusion, “bad” saturated fats like lard, butter, palm oil, and coconut oil are low in omega-6s. This is one reason why standard nutritional advice has begun to recommend a balance of saturated and polyunsaturated fats. But the real culprit, it seems, isn’t so much the food we eat in its natural state but processed foods. Soy oil is cheap and readily available, lending itself to use in hundreds of packaged foods. Beef raised in feedlots on grain to achieve maximum bulk in the shortest period of time are much higher in omega-6s than grass-fed beef (not to mention the widespread use of antibiotics and hormones in the beef and dairy industry). Also high in omega-6s are pork and chicken produced on conventional grain feed in the “factory” system, along with factory eggs.
This is why one of the harder choices we present is switching to grass-fed beef, along with naturally fed (also called pastured) chickens and their eggs. “Free range” isn’t always reliable, since the birds might still be receiving some conventional feed. What makes this choice hard is that it’s expensive, and most of the sources aren’t supermarkets.
We didn’t bring up the issue of omega-6 imbalance to alarm you, only to illustrate the complexity of how food interacts with the body. Rebalancing the fatty acids in your diet comes down to some easy steps, with a general emphasis, as mentioned previously, of moving toward a plant-based diet, as the authors have chosen to do, even though it’s not strictly vegetarian:
• Cook with safflower and olive oil; canola oil isn’t as good but is acceptable.
• Eat unsalted or low-salt tree nuts, including walnuts, almonds, pecans, and Brazil nuts. Limit the amount of fatty nuts, such as cashews and macadamias, as well as peanuts.
• Eat seeds, including unsalted chia, sunflower, pumpkin, hemp, and flaxseeds.
• Eat fatty fish—no more than 6 ounces per week. If vegetarian, eat more lower-fat tree nuts, such as walnuts and almonds, and seeds.
• Avoid packaged foods with soy oil high in the list of ingredients.
• Don’t cook with soy, sunflower, or corn oil.
• Cut back or eliminate conventionally raised beef, pork, and chicken.
• With any meat and poultry, buy lean cuts and trim the fat from other cuts.
There is indication that our diets shouldn’t just be lower in omega-6s but much higher in omega-3s. Therefore it’s a major challenge to turn the American diet around. (Vegetarians who rely heavily on soy products like tofu and whole soybeans would be even more challenged.) Should you make a major push toward omega-3 fatty acids? Some experts believe that these should actually outnumber omega-6s in the diet, but we think the jury is still out on this issue. Among native populations, the Inuit, with their traditional marine diet and high intake of fish, are the only ones who have reversed the ratio, with omega-3s outnumbering omega-6s by 4:1. The Inuit were held up in the early excitement over omega-3s as examples of people with a very low risk of heart disease. But later studies found that the evidence for this claim was fragile, and in addition, the blood-thinning properties of omega-3 fatty acids may be why Inuit have higher than normal mortality from strokes. The larger point is that getting excited over “miracle” foods or nutrients and worried over forbidden ones is a recipe for confusion. The great strength of human digestion is its adaptability. We are the ultimate omnivores. But we are also the only creatures who modify their diet according to ideas in our head and the traditions we are born into.
We respect innovative ideas and traditions, but they also can be excuses for resisting good science and pursuing fads. Taking the route of easy choices seems best. The story doesn’t end with diet, of course. There are five more areas of lifestyle that complement the ability of food to change your microbiome, epigenome, and brain activity. Sometimes they work through anti-inflammation, yet there are other mechanisms that bring major benefits, too. Easy choices with life-changing results can come from many directions.