You have more energy and feel less tired.HEALTHY EATING IS ONE OF YOUR BEST personal investments. It is a central player that influences your health. No matter what the media or your friends say, there is no one best way of eating that fits everyone; there is no perfect food.
Eating healthy means that most of the time you make good and healthful food choices. It does not mean being rigid or perfect. It can mean finding new or different ways to prepare your meals to make them tasty and appealing. If you have certain health conditions, it may mean that you have to be choosier. Eating well does not usually mean you can never have the foods you like most.
Unfortunately, thanks to the Internet, books, other media, friends, and relatives, we can get overloaded with information about what we should and should not eat. The whole eating thing gets very confusing. In this chapter we give you basic science-based nutrition and diet information. We are not going to tell you what to eat or how to eat. That is your decision. We will tell you what is known about nutrition for adults and some ways to help you fit that information to your specific likes and needs. On pages 192–194 we give information for individuals with the most common long-term health conditions. We hope that this chapter will help you start making changes on your way to healthier eating.
Special thanks to Bonnie Bruce, DrPH, RD, for her help with this chapter.
The human body is a very complex and marvelous machine, much like an automobile. Autos need the proper mix of fuel to run right. Without it, they may run rough and may even stop working. The human body is similar. It needs the proper mix of good food (fuel) to keep it running well. It does not run right on the wrong fuel or on empty.
Healthy eating cuts across every part of your life. It is linked to your body and your mind’s well-being, including how your body responds to some illnesses.
When you give your body the right fuel and nourishment, here’s what happens:
You have more energy and feel less tired.
You increase your chances of potentially preventing or lessening further problems from health conditions such as heart disease, diabetes, and cancer.
You feed your brain, which can help you handle life’s challenges as well as its emotional ups and downs.
At the heart of healthy eating are the choices we make over the long run. Healthy eating is being flexible and allowing yourself to occasionally enjoy small amounts of foods that may not be so healthy. There is no such thing as a perfect eating style. Being too strict or rigid and not allowing yourself ever to have a treat will likely cause your best efforts to fail.
For some of us, healthy eating means having to be somewhat choosy about the foods we eat. For example, people with diabetes need to watch their carbohydrate intake to manage their blood sugar levels. They do best each day by deciding which carbohydrate foods, such as fruit, breads, beans, cereals, and rice, they will eat. Others, who have heart disease or are at risk for heart disease, find that watching the amount and kinds of fat they eat can help control their blood cholesterol levels. Those with high blood pressure find that they can help lower their blood pressure by eating lots of fruits, vegetables, low-fat dairy foods, and for some people cutting back on salt. To lose or gain weight, we need to pay attention to how many calories we eat.
We have come a long ways since meat and potatoes were thought of as the backbone of a great diet. Today, vegetables, fruits, whole grains, low-fat milk and low-fat milk products, lean meats, poultry, and fish are at the core of a great diet. There is still a place for meat and potatoes; it is just not the most important place.
The real issue for most of us is not the healthy foods we choose but the less healthy ones. One-third of most American diets is made up of foods that are high in added sugars, solid fats (butter, beef fat [tallow, suet], pork fat [lard], chicken fat, stick margarine, shortening), and sodium (salt). We also eat a lot of food that is made from white flour and other refined grains. These added sugars, fats, and sodium contribute to such health problems as high blood pressure, diabetes, and obesity.
Trade-offs are a big part of healthy eating. This means learning how food affects you and then deciding when you can treat yourself and when you should pass. For instance, it may be important for you to have a very special meal on your birthday, but then you can trade off and make healthier choices when you are out for a casual lunch. Trading off is a tool that can help you stay on the path of healthy eating. As you get better at this, you will find it gets easier and even becomes part of your everyday life.
Most dietary guidelines suggest that a good starting place is to move toward eating more plant foods: whole grains, fruits, vegetables, cooked dry beans and peas, lentils, nuts, and seeds. This does not mean giving up meats and other foods high in sugar, fat, or sodium but rather eating them in smaller amounts or less often. Many current dietary guidelines recommend moderate amounts of lean meats, poultry, and eggs. Balance in the kinds of foods you eat and how much you eat are the primary elements. (We’ll have more to say about this a little later in this chapter.)
This all sounds simple, but every day we are faced with hundreds of food choices. It is often easier and quicker to grab something less healthful than to think about what we will eat, much less cook the food. So how do we put together meals that are tasty and enjoyable yet healthful? Let’s try to make it as simple as possible.
Choose foods as nature originally made them. This means the less processed the better. By processed we mean foods that have been changed from their original state by having ingredients added (often sugar or fat) or removed (often fiber or nutrients) to make them tastier—for example, whole grains made into white flour for bakery products or animal foods made into luncheon or deli meats. Foods that are least or minimally processed include a grilled chicken breast instead of fried breaded chicken nuggets, a baked potato (with skin) rather than French fries, and whole grains, such as whole-grain bread and pasta and brown rice, instead of refined grains such as white bread and white rice.
Get your nutrients from food, not supplements. We know that for most people, vitamin, mineral, and other dietary supplements cannot completely take the place of food. Foods as nature makes them contain nutrients and other healthy compounds (such as fiber) in the right combinations and amounts to do the body’s work properly. When we remove nutrients from their natural state in food, they may not work the way they should. They may even have harmful side effects.
For instance, take beta carotene, an important source of vitamin A, found in plant foods such as carrots and winter squash. It helps our vision and enhances our immune system. However, artificial beta-carotene supplements have been shown in some people to increase some cancer risks. This same risk does not happen when beta carotene is eaten as it is naturally found in food.
Another reason to get your nutrition from foods as close as possible to how nature made them is that these choices could contain as yet unknown healthful compounds. When you take a supplement such as a vitamin pill, you could be missing out on many other helpful substances that are naturally packaged with the food from which the vitamin was removed.
In most of the world, including the United States, diet and nutrition supplements do not have to follow government rules for quality or goodness. Unlike over-the-counter medications, with supplements there is no guarantee that you are getting what you pay for or that you are not getting harmful substances.
Is there ever a place for dietary supplements? Yes, sometimes we cannot get enough of one or more of the nutrients we need. For example, older men and women need a large amount of calcium to help prevent or slow osteoporosis. Although we could get enough calcium from milk and milk products such as yogurt or cheese, getting the amount needed can be difficult. If you are thinking of taking a supplement, talk to your health care professional or a registered dietitian first.
Eat a wide variety of colorful and minimally processed foods. The more variety in your foods, the better; the more colors on your plate, the better; and the less processed your food, the better.
By following these three simple rules, your body will probably get all the good things it needs. This means a plate that contains minimally processed meat, fish, or poultry and a lot of colorful fruits and vegetables—think blue and purple for grapes and blueberries; yellow and orange for pineapple, oranges, and carrots; red for tomatoes, strawberries, and watermelon; and green for spinach and green beans—along with the white and warm brown tones from mushrooms, onions, and cauliflower and whole grains such as brown rice.
Eat foods high in phytochemicals. Phytochemicals are compounds that are found only in plant foods—fruits, vegetables, whole grains, nuts, and seeds (phyto means “plant”). There are hundreds of health-promoting and disease-fighting phytochemicals. These include compounds that give fruits and vegetables their bright colors. Whenever a food is refined or processed, as when whole wheat is made into white flour, phytochemicals are lost. The more often you choose foods that are not refined, and as close as possible to how nature made them, the better.
Eat regularly. A gas-fueled vehicle will not run without the gas, and a fire eventually burns out without more wood. Your body is much the same. It needs refueling regularly to work at its best. Eating something, even a little bit, at regular intervals helps keep your “fire” burning.
Eating at regular times during the day, preferably evenly spaced over the day, also helps maintain and balance your blood sugar level. Blood sugar is a key player in supplying the body, especially the brain, with energy. Usually, the brain can only use blood sugar for energy. If you do not eat regularly, your blood sugar drops, and depending on how low it gets, low blood sugar can cause weakness, sweating, shaking, mood changes (irritability, anxiety, or anger, for example), nausea, headaches, or poor coordination. Low blood sugar (hypoglycemia) can be dangerous for many people.
Eating regularly helps you get the nutrients you need and helps your body use those nutrients. Of course, not skipping meals or not letting too many hours go between meals also helps keep you from getting overly hungry. Being overly hungry often leads to overeating. This can in turn lead to such problems as indigestion, heartburn, and weight gain.
Finally, eating regularly does not mean that you must stick to the same routine every day. Nor does it mean that you must follow the “normal” pattern of eating three meals a day. Allow yourself room for give and take.
If you have certain health conditions, such as cancer, you may find that sometimes several small meals over the day while at other times fewer, bigger meals work best. For people with diabetes, spacing meals regularly and balancing what you eat is important, but this could mean several small meals a day, three meals mixed with a snack, or just three meals, based on what is best for you.
Eat what your body needs (not more or less). This is easy to say but more difficult to put into action. How much you should eat depends on things like the following:
Your age (we need fewer calories as we get older)
If you are a man or woman (men usually need more calories than women)
Your body size and shape (in general, if you are taller or have more muscle, you can eat more)
Your health needs (some conditions affect how your body uses calories)
Your activity level (the more you move or exercise, the more calories you can eat)
Stop eating when you first feel full. This helps you control the amount you eat and helps prevent overeating. Pay attention to your body so you can learn what this feels like. Like all new skills, it takes some practice. If it is hard to stop eating when you begin to feel full, remove your plate or get up from the table, if you can.
Eat slowly. Eating slowly gives you more enjoyment and helps prevent overeating. Make your meals last at least 15 to 20 minutes. It takes this much time for the brain to catch up and tell your stomach that it is getting full. If you finish quickly, wait at least 15 minutes before getting more food. If this is difficult, there are some more tips on pages 198-199.
Pay attention to what you eat. If you are not aware of what you are doing, it is easy to eat an entire bag of chips or cookies or eat too much of any bite-sized pieces of food without even knowing it. This can happen easily when we are with friends, using the computer, or watching television. In these situations, try portioning out what you want to eat or keeping food out of reach or out of sight.
Know a serving size when you see one. To do this, you need to know a little about what a serving size or portion looks like. A ½-cup portion is about the size of a tennis ball or a closed fist. A 3-ounce portion of cooked meat, fish, or poultry is about the size of a deck of playing cards or the palm of your hand. The end of your thumb to the first joint is about 1 teaspoon; three times that is a tablespoon. (Tip: Using a measuring cup is a great way to see what a serving size looks like.)
Watch out for supersizing and portion inflation. In recent years, serving sizes have literally “beefed up.” The typical adult cheeseburger used to have about 330 calories; now it has a whopping 590 calories. Twenty years ago, an average cookie was about 1½ inches wide and had 55 calories; now it is 3½ inches wide and has 275 calories—five times the calories! Soda typically came in 6½-ounce bottles with 85 calories; today it’s 20 ounces to a bottle, with 250 calories.
It takes an extra 3,500 calories more than we need to gain a pound of body fat. This means that over one year’s time, only an extra 100 calories a day will cause you to put on 10 pounds. This is equal to each day eating only an extra third of a bagel! There are many published ranges of recommended serving sizes for different foods. In the food guide on pages 186–192, we list some common serving sizes for a variety of foods along with selected nutrients.
When practical, select single-size portions. Foods that come prepackaged as single servings can help you see what a suggested serving should look like. If that serving size seems too small compared to what you would usually eat, we suggest that you start slowly by cutting how much you now eat by just a small amount at a time. For example, if you usually eat 1 cup of rice, try eating ½ cup instead.
Make your food attractive. We really do eat with our eyes! Compare the mouth-watering appeal of a plate with white fish, white rice, and white cauliflower with one of golden brown chicken, grilled sweet potato, and bright green spinach. Which of these two meals seems more appetizing?
A map will help you along your path and get you to where you are going. The U.S. Department of Agriculture’s Map for Healthy Eating in Figure 11.1 helps you see what a healthy meal should look like. Put your meal together so that one-fourth of the plate is covered with colorful fruit, one-fourth with vegetables, one-fourth with a protein source (lean meat, fish, or poultry, or better yet, plant foods such as tofu, cooked dry beans, or lentils), and the remaining one-fourth with grains (preferably at least half from whole grains) or other starches such as potatoes, rice, yams, or winter squash. Finish off your plate with calcium-rich foods. These could be milk or foods made from milk (preferably fat-free or low-fat), such as cheese, yogurt, frozen yogurt, puddings, or calcium-fortified soy foods such as soymilk. Of course, your food choices and amounts will depend on what you like and need. If you would like more information about this way of eating, check out the USDA’s MyPlate Web site at http://www.chooseMyPlate.gov.
Figure 11.1 MyPlate: A Map for Healthy Eating
For people with diabetes, the American Diabetes Association recommends a similar plate, shown on page 193.
Even with this map, calories and portion sizes are important. Plate sizes are now larger, making it is easier to get more calories than you want or need. Table 11.1 on page 180 can help you plan. It gives you examples of recommended daily portions from different food groups. Note that these amounts are general recommendations and may be different if you have special dietary needs. If you have questions, check with your doctor or a registered dietitian.
Note, too, when you go to the Internet, you will find many people who say they are nutrition experts, but they may not be. If you want a real expert, look for a registered dietitian (RD). These health professionals are specially trained and are the best sources for diet and nutrition advice and information.
Earlier we talked about the need to get nutrients from food. In the following sections, we talk about carbohydrates, fats, protein, water, and a few vitamins and minerals. In addition, although it is technically not a nutrient, we also talk about fiber. Fortunately, it is quite easy to get everything that we need from healthy eating.
First, take a look at Table 11.1, Daily Recommended Servings, with Examples for Healthy Meal Planning. It shows the number of recommended servings for adult women and men along with examples of serving sizes. These recommendations are for people who do less than 30 minutes of moderate exercise a day and eat 1,000 to 3,000 calories. If you have a special health problem or condition, such as diabetes, you may need to change how much you eat of certain foods. Even so, you can still follow the Map for Healthy Eating. We discuss some special dietary issues such as diabetes later in this chapter.
With few exceptions, carbohydrates are your body’s go-to fuel for the brain, central nervous system, and red blood cells. Carbohydrates largely determine your blood glucose (sugar) level—more so than protein or fat. But carbohydrates do a great deal more. They also provide us with basic materials to help make other vital parts for the body. Nearly every part of your body, from your toenails to the top of your head, probably used some part of a carbohydrate in its construction. These include hormones, fats, cholesterol, and even some vitamins and proteins.
Carbohydrates are found mostly in plant foods. Milk and yogurt are about the only animal foods with more than a very small amount of carbohydrate. Foods with carbohydrates can be categorized by whether they are high in sugar or high in starch. Foods that are high in sugar usually break down faster, get into your blood faster, and give you energy faster than high-starch foods. Many minimally processed plant foods also contain fiber. Although fiber is essentially not absorbed into the body and does not have calories, it helps you in important ways.
Sugary carbohydrates are found in fruit and juice, milk, yogurt, table sugar, honey, jellies, syrups, and sugar-sweetened drinks. There are also a lot of other sugars (maltose and dextrose among them) that are found naturally in foods and are often added to processed foods.
Starchy carbohydrates are found in vegetables such as corn, green peas, potatoes, winter squash, dried beans and peas, lentils, and grains such as rice. Pasta, tortillas, and bread are also high in carbohydrates. The amount of carbohydrate in whole grains, brown rice, and whole wheat bread is similar to that in refined grains, such as white bread and white rice. The big difference between them is that the refined grains have lost nutrients, phytochemicals, and fiber during processing.
Fiber is found naturally in whole and minimally processed plant foods with “skins, seeds, and strings.” For example, whole grains, dried beans, peas, lentils, fruits, vegetables, nuts, and seeds all have some fiber. Some foods have added fiber (as when pulp is added to juice). Animal foods and refined and processed foods (white flour, bread, many baked and snack foods) have little or no fiber unless it was added by the manufacturer.
Different types of fiber help your body in different ways. Wheat bran, some fruits and vegetables, and whole grains act as “nature’s broom”; they keep your digestive system moving and help prevent constipation. The fiber in oat bran, barley, nuts, seeds, beans, apples, citrus fruits, carrots, and psyllium seed can help manage your blood sugar because they help slow the amount of time it takes for sugar to get into the bloodstream. They can also help lower blood cholesterol. High fiber diets are also thought to help reduce the risk of rectal and colon cancers.
Most of us think that all fat is bad for us. But we need some fat for survival and for your body to work properly. The body needs about a tablespoon of fat a day. Fat can also be used almost without limit by our bodies to store energy as body fat.
Tips for Choosing Healthier Carbohydrates and Increasing Fiber
Fill at least half of your plate with different kinds of vegetables and whole fruits.
At least half of the grains you eat should be whole grains (brown rice, whole-grain breads and rolls, whole-grain pasta, and tortillas).
Choose foods with whole wheat or a whole grain (such as oats) listed first on the ingredients list on the food label.
Choose dried beans and peas, lentils, or whole-grain pasta instead of meat or as a side dish at least a few times a week.
Choose whole fruit rather than fruit juice. Whole fruit contains fiber, takes longer to eat, fills you up better than juice, and can help keep you from overeating.
Choose higher-fiber breakfast cereals such as shredded wheat, Grape-Nuts, or raisin bran.
Eat higher-fiber crackers, such as whole-rye or multigrain crackers and whole-grain flatbread.
Snack mostly on whole-grain crackers or breads, whole fruit, or nonfat yogurt rather than sweets, pastries, or ice cream.
When you add fiber to your diet, do it gradually over a period of a few weeks. Drink plenty of water to process the fiber and prevent constipation.
Although all fats for the same portion size have the same number of calories, some fats are more healthful than others (we call these good fats), and some can be harmful when we eat too much (bad fats).
Good fats (also called unsaturated fats) are by and large oils that are usually liquid at room temperature. They help keep our cells healthy, and some can help reduce blood cholesterol. Good fats include soybean, safflower, corn, peanut, sunflower, canola, and olive oils. Nuts, seeds, and olives (and their oils), as well as avocados, are also rich in good fats.
There is another group of good fats, the omega-3s, which can be helpful for some people in reducing the risk of heart disease and may help with rheumatoid arthritis symptoms. These fats are found in fatty deepwater fish such as salmon, mackerel, trout, and tuna. Other sources of omega-3s include wheat germ, flaxseed, and walnuts, although the body may not use omega-3s from plants as well as it does the omega-3s from fish.
Tips for Choosing Good Fats and Healthier Fats
The following tips will help you eat less bad fat and more good fat. Just be sure that if you decide to choose more good fats, you are eating less bad fat. You do not want to increase the amount of fat you eat.
When Choosing Foods
Keep cooked portions of meat, fish, and poultry to 2 to 3 ounces. This is about the size of a deck of cards or the palm of your hand.
Do not eat the skin on poultry.
Eat more deep-water fish, such as salmon, tuna, and mackerel.
Choose leaner cuts of meat (round, sirloin, or flank).
Trim off all the fat you can see from meat before cooking.
Use low-fat or fat-free milk and dairy foods (cheese, sour cream, cottage cheese, yogurt, and ice cream).
In cooking and baking, use oil (such as olive or canola oil) and soft (tub) margarines instead of shortening, lard, butter, or stick margarine.
When Preparing Foods
Use a nonstick pan or a pan with small amounts of cooking oil spray.
Broil, barbecue, or grill meats.
Avoid frying or deep frying foods.
Skim the fat from stews and soups during cooking. (If you refrigerate them overnight, the solid fat lifts off easily.)
Use less butter, margarine, gravies, meat-based and cream sauces, spreads, and creamy salad dressings.
The bad fats (also called saturated fats) are usually solid at room temperature (think shortening, butter, lard, and bacon grease). They can increase blood cholesterol and the risk of heart disease. Most bad fats are found in animal foods such as butter, beef fat (tallow, suet), chicken fat, and pork fat (lard). Other foods high in bad fats include stick margarines, red meat, regular ground meat, processed meats (sausage, bacon, luncheon and deli meats), poultry skin, whole- and low-fat milk, whole-milk and low-fat cheeses including cream cheese and sour cream. Palm kernel oil, coconut oil, and cocoa butter are also considered bad fats because they are high in saturated fat.
The fats classed as “deadly” are the trans fats. They have more harmful effects on our blood cholesterol and risk of heart disease than the bad fats. Trans fats are found in many processed foods, including pastries, cakes, cookies, crackers, icing, margarine, and most microwave popcorn. They are listed on food labels as “partially hydrogenated” or “hydrogenated” oils. Be warned! Food companies can legally claim “no” or “0” trans fats on the label even when the food has up to half a gram (0.5 g) per serving. The best advice is to eat as little trans fats as possible.
There are no specific daily recommendations for how much fat you should eat. Most people get more than enough. The best recommendation is to eat very little bad and deadly fats and to replace them with the good fats, without increasing the amount of fat you eat.
There is one more thing you should know about fat. All fats contain twice the calories per teaspoon as protein or carbohydrate. Calories from fat add up quickly. For instance, 1 teaspoon of sugar has about 20 calories, but 1 teaspoon of oil or solid fat has about 35 calories. When we eat more calories than we need—no matter where they come from—the extra calories get stored as body fat, which leads to weight gain.
Protein is vital for hundreds of activities that keep you alive and healthy. Protein is part of your red blood cells and the enzymes and hormones that help regulate the body, as well as your muscles. It helps your immune system fight infection and builds and repairs damaged tissues. Protein can also give you some energy. But like fat, protein is not as good a source of energy for the body as carbohydrate.
There are two types of proteins, based on how they are built. Complete proteins have all the right parts in the right amounts. Your body uses them just as they are. Complete proteins are found in animal foods—meat, fish, poultry, eggs, milk and other dairy products—as well as in soy foods such as soybeans, tofu, and tempeh. Incomplete proteins are low in one or more parts. They are found in plant foods such as grains, dried beans and peas, lentils, nuts, and seeds. Most fruits and vegetables contain much less, if any, protein. For your body to be able to use incomplete proteins best, eat them with at least one other incomplete protein or along with a complete protein.
Over centuries, people have learned to survive by eating protein combinations. Two of the most plentiful and commonly eaten incomplete protein pairs are beans and rice and peanut butter and bread. Although nearly all plant proteins are incomplete proteins, they are at the heart of eating healthy. By eating a small amount of an animal protein (such as chicken) with a plant food such as lentils or black beans, you get all the benefits of a complete protein. In addition, some plant foods, such as nuts and seeds, are sources of the good fats, and many plants foods are good sources of fiber. Plant foods have no cholesterol and little to no trans fats.
Table 11.1 Daily Recommended Servings, with Examples for Healthy Meal Planning
These recommendations are for average adults (19 years and older) who exercise less than 30 minutes daily and eat 1,000 to 3,000 calories. They are based on the United States Dietary Guidelines.
If you have a special condition, you may need to modify portion sizes of certain foods but should aim for an overall balance.
The good news is that most people eat more than enough protein. Unless you have a special medical condition, there is no need to be concerned. Unfortunately, many people get most of their protein from meat, which tends to be high in the bad fats. The best way to get protein is mainly from plant foods along with small amounts of lean meat, poultry, or fish.
Vitamins help regulate the body’s inner workings. Minerals are part of many cells and cause important reactions to happen in the body. All vitamins and minerals are essential for survival and health, and most of us can get what we need from healthy eating. But the minerals, sodium, potassium, and calcium stand out because they are related to current health problems, and many of us eat either too much or too little of these nutrients.
For some people, too much sodium can raise blood pressure. This can lead to heart disease, stroke, and kidney failure. Cutting back on sodium can help lower blood pressure, and it can help prevent high blood pressure.
It is easy to get enough sodium to meet our bodies’ needs, but most of us get way too much. We need only about 500 milligrams a day (in terms of table salt, this is less than a fifth of a teaspoon). Yet most people eat 8 to 12 times that much. Adults should limit sodium intake to 2,300 mg a day, which is about the amount in 1 teaspoon of table salt. People who have high blood pressure, kidney disease, or diabetes, are African American, and who are middle-aged or older should not have more than 1,500 mg of sodium a day.
We get sodium from most foods we eat—from teeny amounts in some plant foods to higher amounts in some animal foods. But the real culprits are processed foods, which typically have a lot of different forms of sodium added to them.
Our love of sodium is learned. It is not something we are born with. Cutting down takes some getting used to, but over time you will learn to enjoy the natural flavors of food. Here are some tips to help you keep your sodium intake in check:
Always taste your food before salting it; many times, it is good as is.
Don’t add salt to food when cooking; season with spices, herbs, pepper, garlic, onion, or lemon.
Use fresh or frozen minimally processed poultry, fish, and lean meat, instead of canned, breaded, or prepared packaged food.
Choose foods labeled “low sodium” or those with 140 mg or less per serving. (Check out the Nutrition Facts label for this information.)
Save high-sodium food for special occasions. Serve bacon, luncheon or deli meats, frozen dinners, packaged mixes, salted nuts, salad dressings, and high-sodium canned soups as part of celebrations, not as everyday fare.
In restaurants, ask that your food not be salted during preparation.
This mineral helps regulate our heartbeat, among other important jobs in the body. In contrast to sodium, which raises blood pressure, potassium can help lower blood pressure. When you follow the Map for Healthy Eating, it is easy to get enough potassium. Lots of vegetables are good sources. These include broccoli, peas, lima beans, tomatoes, potatoes, sweet potatoes, and winter squash; fruits, including citrus fruits, cantaloupe, bananas, kiwifruit, prunes, and apricots; and nuts. Meat and poultry, some fish (salmon, cod, flounder, and sardines), and milk, buttermilk, and yogurt also contain some potassium.
You probably know that calcium helps build bones, but did you know that it is also needed for blood clotting and helps with blood pressure? It may also help protect against colon cancer, kidney stones, and breast cancer.
Unfortunately, most people, especially women and young children, do not get enough calcium. Most women under 60 should get the amount of calcium found in 3 cups of milk every day. Other good sources of calcium are yogurt and kefir (a beverage similar to yogurt); calcium-fortified soy, rice, and almond milks and orange juice; seaweed; and leafy greens (bok choy, kale, brussels sprouts, broccoli, kohlrabi, collards, and some other leafy greens). But our bodies cannot use the calcium in spinach, Swiss chard, and rhubarb. Most fruits are low in calcium, except for dried figs (there’s not much in fig cookies, though) and the tropical cherimoya (custard apple).
Water is your most important nutrient. Like the air you breathe, you cannot live without it. More than half of your body is made up of water, and each cell is bathed in it. Water helps keep our kidneys working, helps prevent constipation, and helps us eat less by making us feel full. It also helps prevent some medication side effects.
Although most people can last weeks without food, you cannot typically live longer than a week or so without water. Most adults lose about 10 cups of water a day. However, we usually have no problem getting the six to eight glasses each day many experts recommend. This is especially true when you consider that most liquids and foods we eat contain some water. Remember, you get water from what you drink as well as the food you eat. Even the driest cracker has a tiny bit of water.
To see if you are drinking enough, check your urine. If it is light-colored, you are fine. When you start to get thirsty, you need more water. Milk, juice, and many fruits and vegetables are good sources of water. Beware, though: coffee, tea, and other drinks with caffeine, as well as alcohol, can cause you to lose water. Do not depend on these drinks for your water.
If you have kidney disease or congestive heart failure or are taking special medications, your needs for water may be different. Talk to a registered dietitian or your health care provider.
The Map for Healthy Eating is a general plan designed to work for most of us. However, some people have different needs and likes. These depend on age, sex, body size, activity level, health, and even availability and affordability of food. Here we present some information and guidelines for selected long-term health problems.
The Nutrition Facts Label: “What’s in That Package of Food?”
Food labels help us find out what is in the packaged foods we eat. The Nutrition Facts panel and the ingredients list are two important parts. They tell you what you will be eating, which can help you make better choices. Reading and understanding the information on food labels can be overwhelming. We will focus on the serving size, calories, total fat, trans fat, cholesterol, sodium, and total carbohydrates.
Serving Size
This is the first thing to look at because all of the other information on the label is based on the serving size, and many packages contain more than one serving. But the serving size on the package may not be what you usually eat. If you would usually have less or more than the stated serving size, you have to change all the amounts. For example, if a serving size is ½ cup cooked rice and you eat 1 cup, which is 2 servings, you will need to double all the values. Most serving sizes are stated in cups, ounces, or pieces of the food.
Calories
Total calories are given for the stated serving size. So if you eat more or less than one serving, you will have to do a little arithmetic. On the same line you will see a number for calories from fat. If you want, you can figure out the percentage of calories you will get from fat. This is important if you are interested in how much fat you are eating, but it doesn’t tell you the kind of fat. Divide the calories from fat by the calories in the serving size and then multiply by 100. In this example, divide the 45 fat calories by the 280 in the serving and you get 0.16. Then multiply by 100 to get 16%.
Total Fat, Cholesterol, and Sodium
The total fat number includes good fats (polyunsaturated and monounsaturated), bad fat (saturated), and trans fat in grams (a unit of weight). You can change grams to calories by multiplying by 9. In the example, multiply the 5 g (total fat) by 9 to get 45 calories. This is the same number of calories as shown in the calories from fat line. The amount of calories in all the fats should add up to the calories for total fat. If they don’t, they will be close (due to the arithmetic).
Remember our warning about trans fats! Due to the way food companies are allowed to do the arithmetic, any food with up to ½ (0.5) g per serving of trans fat can be listed as having no trans fat, but you still could be getting some. If the ingredients list has the words partially hydrogenated or hydrogenated, the product contains trans fat (even if the amount of trans fats per serving is 0 g). So trans fats could add up, especially if you have more than one serving.
The cholesterol line tells you the amount of cholesterol by serving size. Because cholesterol is found only in animal foods, this line may be missing or show 0 g for foods not made with animal products. If you are watching the amount of cholesterol you eat, you need to be especially careful because even if a food does not have any cholesterol, it may have bad or trans fat, particularly if it is a processed food. Trans fats can raise your blood cholesterol level more than the cholesterol from food.
To tell if the fat, cholesterol, or sodium is high or low, look at the “% Daily Value” column. Any value of 20% or more is high. If you want to eat less or want to eat more than one serving, look for values of 5% or less. You can see in this example that the values for total fat, saturated fat, and cholesterol are low but sodium is high. Note that % values are not available for trans fats and protein, as there are no recommended Daily Values for them. If you want to learn more about these recommended Daily Values, go to the MyPlate Website, http://www.choosemyplate.gov.
Total Carbohydrate, Dietary Fiber, and Sugars
This section breaks out values for dietary fiber and sugars and is important for people who want to watch or count their carbohydrates. You will also be able to see if a food is high or low in fiber. Most of us should be eating more fiber. Note that there is no % Daily Value for sugar. However, for many people with diabetes, it’s the total amount of carbohydrate that matters, not the specific kind. A general guideline is to keep this amount between 45 to 60 g per meal, assuming three meals a day.
Ingredients List
Always check a package’s ingredients list. It will show you what is in the food you will be eating. Ingredients are listed in order by weight. If you see sugar listed first, then the food contains more sugar than anything else. Remember, too, when you see the words partially hydrogenated or hydrogenated, the product contains trans fats (even if the amount for trans fats is 0 g).
Food Guide for Healthy Meal Planning
Nutritional values are based on data from the United States Department of Agriculture and the American Diabetes Association.
Abbreviations: g = grams, mg = milligrams, oz = ounce, c = cup, Tbsp = tablespoon, tsp = teaspoon
Protein Foods
Animal Protein Sources with Little or No Carbohydrate
BEEF, PORK, LAMB, VEAL, POULTRY, and FISH
Serving Size: 3–4 oz, cooked, NOT breaded, fried, or cooked with added fat unless noted. This portion is the size of the palm of your hand and ½ to 1 inch (1.0 to 2.5 cm) thick.
Per Serving: approx. 21–28 g protein; fat and calories vary
Lean (up to 9 g fat, 135–180 calories)
Beef, fat trimmed, from the round, sirloin, and flank, tenderloin sirloin, ground round
Pork, fresh, cured, boiled ham, Canadian bacon, tenderloin, center loin chop
Lamb and veal, rib roast, chop, leg
Chicken and turkey, white or dark meat, no skin
Duck and goose, drained of fat, no skin
Game, buffalo, ostrich, rabbit, venison
Fish (fresh or frozen), catfish, cod, flounder, haddock, halibut, orange roughy, salmon, tilapia
Fish (canned), tuna, in water or oil, drained; herring, uncreamed or smoked, 6–8 sardines
Shellfish, clams, crab, lobster, scallops, shrimp, imitation shellfish
Oysters (fresh or frozen), 18 medium
Processed meats (luncheon meat, deli meat), turkey ham, kielbasa, pastrami, chipped beef, shaved meats
Medium-fat (12–21 g fat, 150–300 calories)
Beef, ground, meatloaf, corned beef, short ribs, prime rib, tongue
Pork, shoulder roast, Boston butt (picnic), cutlets
Lamb, rib roast and chops, roasts, ground
Veal, cutlet
Chicken, turkey, with skin, fried, ground
Pheasant, dove, wild duck, wild goose
Fish, all fried
High-fat (24 g or more fat, 300–400 calories)
Pork, spareribs, ground
Sausage, pork, bratwurst, chorizo, Italian, Polish, smoked, summer
Processed meats, luncheon meat and deli meats, bologna, salami
Bacon, 6 slices
Serving Size: 2–3 oz
Per Serving: 14–21 g protein; fat and calories vary; high in cholesterol
Kidney (1–3 g fat, 70–105 calories)
Liver, heart (6–9 g fat, 55–100 calories)
Eggs
Per Serving: 7 g protein
Whole egg, 1 large, cooked (5 g fat, 75 calories)
Egg whites, 2 large, cooked (0–1 g fat, 35 calories)
Cheese
Per Serving: 7 g protein; fat and calories vary
Fat-free and low-fat (0–1 g fat, 35 calories)
Fresh (Mexican) and nonfat cheese, 1 oz
Cottage cheese, fat-free, ¼ c
Medium-fat (4–7 g fat, 75 calories)
Feta, skim-milk mozzarella, string cheese, reduced-fat and processed cheese spreads, 1–2 oz
Ricotta, ¼ c (2 oz)
Grated parmesan, 2 Tbsp
High-fat (8 g fat per oz, 100+ calories)
All regular cheese: American, blue, brie, Swiss, cheddar, Monterey jack, Swiss, provolone, whole-milk mozzarella, goat, queso, 1–2 oz
Meat Substitutes
Per Serving: Little to no carbohydrate; fat and calories vary
Nuts and seeds* (5 g fat, 45 calories)
Almonds, cashews, mixed nuts, 6 nuts
Peanuts, 10 nuts
Pecans, walnuts, 4 halves
Tahini (sesame paste), 1 Tbsp
Pumpkin seeds (pepitas), sunflower seeds, 1 Tbsp
Nut butters (peanut, almond, etc.), 2 Tbsp (8 g fat)
Egg substitute, plain, ¼ c (1 g fat, about 50 calories)
*These foods contain good fats (see page 178).
Animal Protein Foods with Carbohydrate
Milk
Serving Size: 1 c
Per Serving: 8 g protein, 12 g carbohydrate; fat and calories vary
Nonfat, fresh or evaporated 1%, nonfat or low-fat buttermilk (0–3 g fat, 100 calories)
Low-fat (2%) sweet acidophilus (5 g fat, 120 calories)
Whole, fresh or evaporated goat, buttermilk (8 g fat, 160 calories)
Yogurt
Per Serving: 8 g protein, 12 g carbohydrate; fat and calories vary
Nonfat, plain or flavored with artificial sweetener, ⅔ c (6 oz) (0–3 g fat, 90–100 calories)
Low-fat, sugar-sweetened, with fruit, ⅔ c (6 oz) (5 g fat, 120 calories)
Plain whole milk, kefir, ¾ c (8 g fat, 150 calories)
Nonfat fruit-flavored, sweetened with sugar, 1 c (30+ g carbohydrate, 0–3 g fat, 100–150 calories)
Nonfat or low-fat fruit-flavored, sweetened with sugar substitute, 1 c (0–3 g fat, 90–130 calories)
Protein Substitutes
Per Serving: as noted
Soymilk, regular, 1 c (4 g fat, 100 calories)
Dried beans and peas, lentils, cooked, ½ c (15 g carbohydrate, 7 g protein, 0–1 g fat, 80 calories)
Edamame (soybeans), ½ c (8 g carbohydrate, 7 g protein, 0–1 g fat, approx. 60 calories)
Hummus (garbanzo bean spread), ⅓ c (15 g carbohydrate, 7 g protein, approx. 8 g fat, 100 calories)
Refried beans, canned, ½ c (15 g carbohydrate, 7 g protein, 0–3 g fat, approx. 100 calories)
Tofu, regular, ½ c (4 oz) (3 g carbohydrate, 8 g protein, 5 g fat, 75 calories)
Per Serving: 15 g carbohydrate, 3 g protein, 0–1 g fat, 80 calories
Tip: Choose whole grains as often as you can.
Breads, Rolls, Muffins, and Tortillas
Bagel, large, ¼ (1 oz)
Buns, hot dog or hamburger, ½
English muffin, plain, ½
Roll, regular, ½
Pancake, 4 inches across, 1
Pita bread, 6 inches across, ½
Tortilla, corn or flour, 6 inches across, 1
Waffle, 4½ inches square, reduced-fat, 1
Bread, white, whole grain,* rye, pumpernickel, 1 slice (1 oz)
Cereals
Bran flakes, spoon-size shredded wheat,* ½ c
Granola,* low-fat or regular, Grape-Nuts* ¼ c
Puffed, unfrosted, 1½ c
Oats,* cooked, ½ c
Grains
Bulgur wheat,* grits, cooked, tabbouleh, prepared, ½ c
Pasta, barley, couscous, quinoa, cooked, ⅓ c
Rice, white, or brown,* cooked, ⅓ c
Wheat germ,* dry, 3 Tbsp
Wild rice,* cooked, ½ c
*Good source of fiber
Crackers and Snacks
Graham crackers, 2½ inches square, 3
Matzo, ¾ oz
Melba toast (2 inches by 4 inches), 4
Pretzels, ¾ oz
Rice cakes, 4 inches across, 2
Saltines, 6
Whole-wheat crackers, no fat added, 3–4 oz (2–5 crackers)
Low-Starch Vegetables
Per Serving: approx. 5 g carbohydrate, 2 g protein, no fat, 25 calories
Serving Size: ½ c cooked or vegetable juice, 1 c raw fresh, frozen, or canned (frozen or canned may be high in sodium)
Amaranth
Artichoke
Asparagus
Bamboo shoots
Bean sprouts
Beets
Broccoli
Brussels sprouts
Cabbage, Chinese cabbage
Carrots
Cauliflower
Celery
Chayote (vegetable pear)
Chicory
Chilies, spicy
Cucumber
Eggplant (aubergine)
Garlic
Green onion, scallions
Greens (collard, kale, mustard, turnip)
Jicama
Kohlrabi
Nopales (cactus)
Mushrooms
Okra
Onions
Pea pods
Radishes
Rutabaga
Salad greens
Snap peas
Spinach
Summer squash (yellow squash, zucchini)
Sweet peppers
Tomatoes (raw, canned, sauce)
Turnips
Watercress
Vegetable juice (usually high in sodium)
Starchy Vegetables
Per Serving: 15 g carbohydrate, 0–3 g protein, 0–1 g fat, 80 calories
Corn, ½ c or ½ large cob (5 oz)
Mixed vegetables with corn, peas, or pasta, 1 c
Parsnips, ½ c
Plantain, ripe, ⅓ c
Potato, baked or boiled, large, with skin, 1 (3 oz)
Succotash (lima beans and corn), ½ c
Winter squash (acorn, butternut, pumpkin), 1 c
Yam, sweet potato, ½ c
Yautia, yuca (cassava), ½ c
Fruit
Per Serving: 15 g carbohydrate, no protein, 0–1 g fat, approx. 80 calories
Fresh
Apple, small, 2 inches, 1 (4 oz)
Apricots, 4
Banana, extra small, 1 (4 oz)
Berries, strawberries, blueberries, raspberries, ¾–1 c
Cherries, ½ c (approx. 12)
Coconut, fresh (shredded), ½ c
Dates, 3
Figs, large, 2
Fruit cocktail, ½ c
Grapefruit, small, ½
Grapes, small, ½ c
Guava, medium, 2
Kiwifruit, large, 1
Lemon, lime, large, 1
Mango, cubed, ½ c
Melon (honeydew, cantaloupe), ¼
Orange, small, 1
Papaya, small, cubed, 1 c
Pineapple, cubed, ¾ c
Peach, nectarine, 1
Pear, ½
Persimmon, medium, 1
Plum, small, 2
Tangerine, small, 2
Watermelon, cubed, ½ c
Canned
Unsweetened, ¼–½ c
In sugar syrup, ¼ c
Dried
Apricots, 8 halves
Figs, 2
Prunes, 3
Juice, unsweetened (if the label doesn’t say 100% juice, it usually contains added sugar)
Apple, grapefruit, orange, pineapple, ½ c
Apricot nectar, ½ c Grape, prune, juice blends, ⅓ c
Juice drinks, sweetened
Carbonated juice drinks, ½ c
Cranberry cocktail, ⅓ c
Raisins, 1 Tbsp
Tamarind, ½ c
Oils and Solid Fats
Per Serving: little or no carbohydrate, 5 g fat, 45 calories
Tip: Choose good fats as often as you can.
Good fats (unsaturated fats) (see page 178)
Salad and cooking oils (corn, olive, safflower, soybean, etc.), 1 tsp
Avocado, medium, ¼
Olives, all types, large, 5
Margarine (soft), reduced-fat, 1 tsp
Mayonnaise, regular, 1 tsp
Mayonnaise, reduced-fat, 1 Tbsp
Salad dressing, 1 Tbsp
Bad fats (saturated fats) (see page 178)
Butter, regular, 1 tsp
Butter, reduced-fat, 1 Tbsp
Bacon fat, 1 tsp
Cream, liquid nondairy creamer, 1 Tbsp
Cream, half-and-half, whipped, 2 Tbsp
Cream cheese, 1 Tbsp
Margarine (stick), regular, made with hydrogenated fat, 1 tsp
Sour cream, regular, 1 Tbsp
Shortening, lard, 1 tsp
Extras
Tip: These foods are high in fat or sugar or both; they’re best saved for special occasions.
Cake with frosting, 1 small slice or 2-inch square
Cookies, small, 2
Danish, small, 1
Flan, with milk, ½ c
Fruit tart or pie, 1 slice
Honey, 1 Tbsp
Ice cream (regular), ½ c
Jam or jelly (regular), 1 Tbsp
Jam or jelly (low-sugar or light), 2 Tbsp
Juice bar (frozen, 100% juice), 1
Pudding, ½ c
Sherbet, sorbet, ½ c
Syrup (regular), 1 Tbsp
Syrup (sugar-free), 2 Tbsp
Per Serving: no protein or fat; carbohydrate and calories vary
Distilled spirits, 80 proof, 1½ oz (0 carbohydrate, 80–110 calories)
Liqueurs, 1½ oz (approx. 20 g carbohydrate, 125 calories)
Wine, red, white, dry, sparkling, 4 oz (1–2 g carbohydrate, 80 calories)
Wine, sweet or dessert, 4 oz (approx. 14 g carbohydrate, 120 calories)
Beer, regular, 12 oz. (approx. 13 g carbohydrate, about 160 calories)
Beer, lite or nonalcoholic, 12 oz (approx. 5 g carbohydrate, 60–120 calories)
Mixed drinks (margarita, mojito, gin and tonic, etc.), 1 drink (approx. 12 g carbohydrate, 150–250 calories)
Free Foods
Per Serving: up to 5 g carbohydrate, up to 20 calories; enjoy moderate servings as often as you like
Atol (cornmeal drink) 1 c
Bouillon, broth, consommé
Candy, hard (sugar-free)
Chewing gum (sugar-free)
Club soda, mineral water
Coffee or tea, unsweetened or with sugar substitute
Gelatin (sugar-free or unflavored)
Herbs, spices
Horchata (rice drink)
Hot pepper sauces
Soft drinks (sugar-free)
Soy sauce
Worcestershire sauce
Sugar substitutes (approved by the United States Food and Drug Administration)
Equal (aspartame)
Splenda (sucralose)
Sprinkle Sweet (saccharin)
Sweet One (acesulfame K)
Sweet-10 (saccharin)
Sugar Twin (saccharin)
Sweet’N Low (saccharin)
When you eat a meal, the body breaks down the carbohydrates into glucose, the basic fuel for the body’s cells, which is then absorbed into the bloodstream. Protein and fat usually contribute little to the body’s blood sugar. The hormone insulin takes the glucose (blood sugar) into the cells. In people with diabetes, cells do not absorb or use glucose very well. Glucose then builds up in the bloodstream, which can lead to other health problems. Managing blood sugar levels is one of the prime goals in diabetes and involves many different things. These include taking medication, exercising, and keeping a careful eye on diet (for more on diabetes, see Chapter 18).
In years past, people with diabetes were told that they could not eat sweets and that they could only eat certain types of carbohydrates. As we learn more, things change. We now know that people with diabetes do not have to avoid any specific food. However, they do need to watch what and how much they eat. These things will vary from person to person.
The American Diabetes Association recommends “Create My Plate” to plan meals. Looking at your plate, divide it in half. Then take one of those halves and divide it in half again. You should have 3 sections on the plate now.
Half of the plate should be non-starchy vegetables, such as spinach, greens, carrots, lettuce, cabbage, bok choy, broccoli, green beans, tomatoes, cauliflower, salsa, cucumber, okra, peppers, mushrooms, beets, turnip
One small section should be starchy food, such as whole grain breads, whole grain cereal, rice, pasta, tortillas, dal, oatmeal hominy, grits, cooked beans and peas, potatoes, corn, lima beach, green peas, sweet potatoes, fat-free popcorn, low fat crackers, pretzels
The other small section should be meat or meat substitute, such as chicken or turkey (without the skin), fish, lean cuts of beef or pork, eggs, low-fat cheese, tofu
Add to that one 8-ounce glass of non- or low-fat milk, or 6 ounces of light yogurt, and a small piece of fruit or ½ cup fruit salad
Figure 11.2 “Create My Plate” from the American Diabetes Association
Here are some general points about healthy eating for people with diabetes:
Follow the Map for Healthy Eating (page 175). People with diabetes are at higher risk for heart disease and other chronic health conditions. Following the Map is especially important to help prevent future problems.
Start each day with something to eat. Eating something in the morning is truly “breaking the fast.” It helps fuel the body after a long night of resting and not having any food; it gives us energy to start the day’s activities.
Regularly space meals and snacks over the day, and don’t skip meals. Spacing your meals at usual times gives your body the chance to produce and use its insulin or time for your medication to work to keep up your energy level. The number of meals you eat and the time between your meals will vary depending on your personal health and lifestyle. Many of us eat three meals a day, while others may prefer or need to eat smaller meals more often.
Eat the same amount of food at each meal. This helps you maintain an even energy flow and blood sugar level throughout the day. Skipping meals or mixing large meals with small meals can throw off your energy level. It can also lead to overeating or making poorer, less healthy food choices. This can in turn cause swings in your blood sugar and result in symptoms such as irritability, shakiness, and mood swings, pain or difficulties breathing due to stomach bloating, heartburn, indigestion, or even poor sleep.
It is important that you learn to manage the carbohydrates you eat. Nearly all carbohydrates break down into glucose, so they have the greatest effect on your blood sugar. Too much carbohydrate causes blood sugar to increase; too little makes your blood sugar low. General guidelines suggest eating between 45 and 60 g of carbohydrates per meal, but this amount may vary widely from person to person.
For most people with diabetes, there is no such thing as a bad carbohydrate or one that is off limits. What matters most is the total amount of carbohydrate, not the specific kind, although some people may feel that certain foods affect them differently. Carbohydrates are found mostly in plant foods (milk and yogurt are exceptions) in the form of sugars (honey, jelly, table sugar, and the like) and starches (dried beans, winter squashes, and grains such as rice and flour). You get the most benefit by getting the majority of your carbohydrates from whole grains (brown rice, oats, whole-wheat bread), fruits (preferably whole fruit rather than juice), vegetables, and dried beans, peas, and lentils. These foods are high in vitamins, minerals, fiber, and other good things that help keep the body healthy and protect it from disease. Also, foods such as barley, dried beans, oats, apples, citrus fruits, carrots, and psyllium seed are absorbed by the body more slowly and can help you manage your blood sugar level. They can also help lower blood cholesterol, which helps lower heart disease risk.
Because of the increased risk of heart disease and stroke, it very important to eat fewer bad fats (saturated and trans fats; see page 178). Instead, replace them (not add to them) with good fats (such as olive and canola oils). In addition, eat more plant foods and fewer animal foods. Get less sodium by eating fewer processed and prepared foods, and use the salt shaker sparingly, if at all. If you are carrying some extra weight, losing some weight can help lower your blood sugar. Even a small weight loss of 5 to 10 pounds (2–4 kg) can make a big difference in your blood sugar level. (See the tips for healthier eating in the boxes on pages 177 and 178, and find tips for choosing healthy fats on page 178).
Healthy eating for people with heart disease or those who have had a stroke usually involves keeping arteries from hardening or getting clogged (for details on heart disease, see Chapter 16). So it is important to watch the amount and kind of fat you eat. Most of the fat you eat should come from the good fats (unsaturated fats) and very little from the bad (saturated) fats. You should eat little to no trans fat. Also, increasing the amount of fiber you eat, especially from oats, barley, dried beans and peas, lentils, apples, citrus fruits, carrots, and psyllium seed can be helpful in managing high blood cholesterol, a major risk factor for heart disease. Eating less salt and sodium can help prevent or control high blood pressure. Try to limit the daily total amount of sodium you get to no more than that found in 1 teaspoon of table salt (about 2,300 mg). Use herbs, spices, lemon, and vinegar for flavor. The tips on page 177 also provide suggestions for ways to make healthy fat choices and increase fiber in your eating plan.
For people with lung disease, especially emphysema, it is sometimes necessary to increase the amount of protein you eat. This helps increase energy, strength, and the ability to fight lung infections. When it is hard for you to eat enough food, as when you have little or no appetite, try eating higher-calorie foods—fruit nectars instead of juice, dried fruit instead of fresh fruit, sweet potato instead of white potato—or try nibbling on a small handful of nuts over the course of the day. Our discussion of the common challenges of gaining weight in Chapter 12 (page 214) gives you some tips to help you increase how much you eat.
If you have specific concerns about what to eat, talk to your doctor or a registered dietitian. These professionals can tell you what’s best for you as well as help you fit our general recommendations to your unique health needs.
Osteoporosis makes bones brittle and easily broken. It has been called a silent disease because its first symptom can be a bone fracture, especially in the spine, hip, or wrist. However, it is never too late to help slow its progress. You can help by getting enough calcium and vitamin D, regularly doing muscle-strengthening and weight-bearing exercise (such as walking; see Chapter 7), and following your health care professional’s recommendations, such as taking prescribed medications for bone loss.
Osteoporosis is technically not a calcium deficiency disease, and after bone has been lost, getting more calcium will not fix it. But getting vitamin D along with enough calcium can help the body absorb the calcium. Everybody needs some calcium every day. The best sources are milk and foods made from milk. But some people avoid milk products because they don’t like them, do not eat animal products, or have problems digesting milk sugar (lactose intolerance). You can get enough calcium from your diet even if you have problems with milk sugar. Many people can enjoy milk products if they take them in small amounts or eat other foods at the same time, like cereal with milk; if they use lactase tablets to help digest the lactose; or if they find that they can eat foods like kefir or yogurt. There are also some fruits and vegetables that are high in calcium, including kale, collard greens, bok choy, and broccoli; calcium-treated tofu; cooked dried beans; and foods with added calcium, such as soymilk, juices, cereals, and pasta. If you think you may not be getting enough calcium, talk to your doctor or a registered dietitian about your diet and whether calcium supplements are needed to meet your calcium needs.
Do you eat when you’re bored, down in the dumps or sad, or feeling lonely? Many people find comfort in food or just eating as something to do when they need to take their minds off something or have nothing else to do. Some eat when they are feeling angry, anxious, or depressed. At these times, it is easy to lose track of what and how much you eat. These are also the times when celery sticks, apples, or popcorn just won’t do. Here are some ways to help control these urges:
Keep a food-mood diary.. Every day, list what, how much, and when you eat. Note how you are feeling when you have the urge to eat. Try to spot patterns so you can anticipate when you will want to eat without really being hungry.
If you catch yourself feeling bored and are thinking about eating, ask yourself, “Am I really hungry?” If the answer is no, make yourself do something else for 2 to 3 minutes—go for a short walk around the house or around the block, work on a jigsaw puzzle, or play a computer game.
Keep your mind and hands busy. Getting your hands dirty is helpful (as with gardening).
Write down action plans for when these situations arise. Sometimes it is easier to refer to the written word than to remember what you said you would do.
“Healthy food doesn’t taste the same as food I am used to. When I eat, I want something with substance, like meat and potatoes or a piece of apple pie! The healthy stuff just doesn’t fill me up!”
Making healthier food choices does not mean that you cannot have something you want or crave. It means trading off to fit in favorites while making the better choices most of the time. Some of these tips are discussed in Chapter 12, and more information is available at the end of this chapter. There are also many excellent cookbooks with healthy recipes, as well as Internet sites with good, healthful recipe ideas.
“But I love to cook!”
If you love to cook, you are in luck. Take a new cooking class, begin watching one on television, buy a new cookbook on healthy cooking, or find an Internet site with healthy recipes. If you have odds and ends, even leftovers, in your kitchen, do a computer search to see what recipes you can find. Play around with ways to modify your favorite recipes, making them lower in fat, sugar, and sodium.
“I’m living alone now, and I’m not used to cooking for one. I find myself overeating so that food isn’t wasted.”
This can be a problem, particularly when the situation is new. You may be overeating or eating a “second dinner” to fill in time. Maybe you are one of those people who will eat for as long as food is in front of you. Whatever the reason, here are some ways to help you deal with the extra food:
Don’t eat “family style” by putting serving dishes on the table. Put as much as you feel you can comfortably eat on a plate, and bring only that plate to the table.
As soon as you have finished eating, or even right after you have served your portion, immediately put leftovers in the refrigerator or freezer. This will also give you leftovers for the next day or whenever you don’t feel like fixing a meal.
Have company over for dinner once in a while so that you can share food and other people’s company. Plan a potluck supper with neighbors, relatives, or members of your house of worship, clubs, or other groups.
“Food doesn’t taste as good as before.”
Many things can affect how food tastes. Having surgery, taking certain medications, being on oxygen, and even the common cold can make food taste off, bad, or funny. When this happens, you tend to eat less. Many people automatically add extra salt to their food to try to make it taste better. Unfortunately, this can cause you to retain water or feel bloated, which can increase blood pressure.
Here’s how you can make foods taste better:
Use herbs (basil, oregano, tarragon), spices (cinnamon, cumin, curry, ginger, nutmeg) in cooking or even sprinkled on top.
Squirt fresh lemon juice on foods.
Use a small amount of vinegar in or on top of hot or cold foods. There are dozens of different kinds, from balsamic to berry- and fruit-flavored varieties; experiment with new flavors.
Add healthy ingredients to the foods you usually eat (carrots or barley to soup, for example, or dried fruits and nuts to salads) to give them more texture and make them tastier.
Chew your food slowly and well. This will allow the food to remain in your mouth longer and release more flavor.
If the lack of taste is keeping you from eating enough, you may need to add more calories to your meals or snacks. Tips for doing this are given on page 215.
“It takes so long to prepare meals. By the time I’m done, I’m too tired to eat.”
This is common, especially when you do not have much energy. This situation calls for planning to help make sure that you do eat. Here are some hints to help:
When you do have some energy, cook enough for two, three, or even more servings or meals, especially if it is something you really like.
Do a meal exchange with friends or family, and freeze what you get in single-serving sizes for times when you are tired.
Break your food preparation into steps, resting in between.
Ask for help, especially for big holiday meals or family gatherings.
“Sometimes eating causes discomfort.”
“I’m afraid I’ll become short of breath while I’m eating.”
“I really have no appetite.”
People who experience shortness of breath or who find it difficult and physically uncomfortable to eat meals tend to eat less. For some, eating a large meal causes stomach problems such as indigestion, discomfort, or nausea. Indigestion, along with a full stomach, reduces the space your breathing muscles have to expand and contract. This can aggravate breathing problems.
If these are challenges you sometimes face, try the following:
Eat four to six small meals a day, rather than the usual three large meals. You will be using less energy for each meal.
Avoid foods that produce gas or make you feel bloated. Many foods can produce gas, although foods affect people differently. Among the more common foods that can cause discomfort are cabbage, broccoli, brussels sprouts, onions, beans, and certain fruits, including bananas, apples, melons, and avocados.
Eat slowly, take small bites, and chew your food well. You should also pause occasionally during a meal. Eating quickly to avoid an episode of shortness of breath can actually cause shortness of breath. Slowing down and breathing evenly reduces the amount of air you swallow while eating.
Do a relaxation exercise about half an hour before mealtime, or take time out for a few deep breaths during the meal.
Choose food that is easy to eat, such as yogurt or pudding, or to drink, like a shake or fruit nectar.
“I can’t eat very much in one sitting.”
There is no rule that says we must eat only three meals a day. In fact, many people find that four to six smaller meals work better. If you choose to eat more frequently, include no-fuss, high-calorie snacks such as shakes, muffins and other baked products, and protein or meal bars as part of these extra meals. If you still can’t finish a whole meal, eat the portion of your meal that is highest in calories first.
“I love to eat out, so how do I know if I’m eating well?”
Whether it is because you don’t have time, you hate to cook, or you just don’t have the energy to shop for groceries or fix meals, eating out may suit your needs. This is not necessarily bad if you know how to make the best choices possible. Here are some tips on eating out:
Select restaurants that have a variety of menu items prepared in healthy ways (for example, grilled or steamed dishes in addition to or instead of fried foods).
Ask what is in a dish and how it is prepared, especially if you are eating in a restaurant where the dishes are new to you.
Before you go out, decide what type of food you will eat and how much. Many restaurants post their menus on the Internet or at the front of the restaurant.
Order small plates or appetizers instead of main courses.
When you are with a group, order first so that you aren’t tempted to change your mind after hearing what others have selected.
See if you can split an entree with a dining companion, or order a half portion. You could also plan to eat only half of what you are served and take the rest home for another meal. Ask to have the take-home container brought to you with your food, and box it up before you start eating.
If you don’t mind wasting food, heavily (really heavily) salt or pepper half of your food so you won’t be able to eat it.
Choose menu items that are low in fat, sodium, and sugar, or ask if they can be prepared that way.
Whenever possible, order broiled, barbecued, baked, grilled, or steamed dishes rather than breaded, fried, sautéed, creamed, or covered in cheese.
Ask for vegetables steamed or raw without butter, sauces, or dips.
Eat bread without butter, or ask that no butter or dipping oil be served with it.
Request salad with dressing on the side, and dip your fork into the dressing before spearing each mouthful.
For dessert, select fruit, nonfat yogurt, sorbet, or sherbet.
Share an entrée or a dessert with at least one other person.
“I snack while I am doing other things—watching TV, working on the computer, or reading.”
If this is a problem for you, plan ahead by keeping a list of healthier snacks to grab. Here are some examples:
Rather than snack crackers, chips, and cookies, munch on fresh fruit, raw vegetables, or fat-free or plain popcorn.
Measure out your snack in a single-portion size so you won’t be tempted to eat more.
Make specific places at home and work “eating areas,” and don’t eat anywhere else.
Healthy eating is about the food choices you make most of the time. It is not about never being able to eat certain foods. There is no such thing as a perfect food or a bad food. Healthy eating means enjoying a moderate amount of a wide variety of minimally processed foods in the proper amounts for your body while allowing for occasional treats. Eating this way can help you maintain your health, help prevent future health problems, and help you manage your disease symptoms as best possible. Eating healthy, however, may mean making some changes to what you are now doing. These could include making more food choices that are higher in good fats and fiber and fewer food choices that are high in bad and trans fats, sugar, and sodium. Healthy is equally important to whether you want to lose weight and keep it off, maintain your weight, or gain weight (see Chapter 12).
If you choose to make some of the changes suggested in this chapter, think of this as doing something positive and wonderful for yourself, not as punishment. As a self-manager, it’s up to you to find the changes that are best for you. And if you experience setbacks, identify the problems and work at resolving them. You can do it!
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