What if I hate lettuce? Do I really needs to eat my greens?
Greens are all good, and one of the few foods you can eat pretty much without limit. These plants are all very low in calories and highly concentrated in diverse nutrients: antioxidants, fiber, vitamins, and minerals.
What are the best antioxidants to take and what are easy ways to get them in our diet?
Eat a variety of vegetables and fruits and you’ll get all the antioxidants you need. There is no good evidence that antioxidant supplements confer the benefits of a diet rich in antioxidants. Other good sources include coffee, tea (especially white and green), dark chocolate and cocoa, whole grains, legumes, nuts and red wine.
Wine! I’ve heard moderate alcohol consumption is good.
Alcohol is the quintessential double-edged sword: There’s a chance for some benefit, but there are risks as well. There’s the relaxation factor, which is immeasurable, and the consensus, which is pretty clear, is that “moderate” consumption may be beneficial and, even more likely, isn’t harmful. “Moderate” means two glasses per day for men; one for women. (Men have higher levels of alcohol dehydrogenase than women, and thus metabolize alcohol more efficiently than women.) There is an association of almost any level of alcohol intake with increased cancer risk, including breast cancer in women and of course liver cancer.
So what is the healthiest alcohol? Is tequila as clean as the hype? Should I aim for low carbs or low calories?
If you think you are drinking alcohol for health, stop now. If you’re drinking it for pleasure, keep your intake moderate and don’t worry about the form, as long as it’s not — for example — paint thinner. If your question is about calories, spirits are the most efficient alcohol in terms of bang for buck; beer is the least. Of course if you take your spirits with ginger ale, it’s a different story.
What about the theory that red wine is good for you?
The antioxidants from the skins of grapes may confer unique health benefits, which would suggest red wine is the best form of alcohol. Again, don’t drink because you think it’s the healthy thing to do.
What about coffee? Please don’t take away my coffee! Caffeine has positive effects, right?
Positive and negative.
What are the positive effects?
Positive: alertness, slightly enhanced cognition.
I’m going to regret asking this but — what are the negative effects?
Negative: potential increases in heart rate, blood pressure, jitteriness, and insomnia.
I love lattes, but which milk should I use? Are nut milks just flavored water?
No. But nut milks aren’t nutritional powerhouses, either. (Of course, like dairy milk, many such products are nutrient fortified.)
What about oat milk? How do you milk an oat?
Oat milk is made by soaking oats in water, then grinding and straining.
So that is basically oat-flavored water?
Well, with some of the nutrients featured in oats.
Do I need to drink milk at all?
Only if you were born yesterday. Literally.
I thought I needed the calcium. How much calcium does an adult need?
How much calcium we need to eat daily varies with factors such as our activity level, dietary pattern, protein intake, acid load (from foods and medications), life stage (e.g., pregnancy, lactation, senescence), and so on. The closest thing to a one-size-fits-all amount is: roughly 1,000 mg per day.
What are non-dairy sources of calcium?
Kale and other dark leafy greens, beans, soy. Calcium is actually quite widely distributed in the food supply.
But really, in 2018, I’m all about inflammation, which is bad and causes diseases. I’m sure I read that somewhere.
Inflammation is not bad; we need “inflammatory” responses to defend ourselves against germs, and the rogue cells that can cause cancer.
Okay, but it’s sometimes bad. Right?
What is bad is imbalance, and we tend to have an excess of inflammatory exposures and a deficiency of anti-inflammatory exposures. So, for instance, refined carbohydrate and added sugar tend to be inflammatory because they drive up insulin levels and insulin triggers inflammatory responses. We tend to get more saturated and omega-6 fat than we should (from processed foods and many of the oils used in them), and these are inflammatory. Omega-3 fat (from fish, seafood, walnuts, certain seeds) and monounsaturated fat (from olive oil, avocado, nuts and seeds) are anti-inflammatory.
Wait, wait, wait. You lost me at “monounsaturated.” Can you make this simpler?
Water instead of soda: good.
Whole grains instead of refined grains: good.
Nuts, seeds, olive oil, avocado: good.
Fish and seafood in the place of meat: good.
In other words, an “anti-inflammatory” diet is a good diet, one that avoids highly processed foods, lots of meat, lots of full-fat dairy, refined carbs and added sugar, and is instead made up mostly of vegetables, fruits, beans, lentils, whole grains, nuts, seeds, and plain water.
But not seltzer water.
Plain seltzer is fine for generally healthy people, and a far better choice than any of the popular sugary drinks.
Doesn’t seltzer water decalcify your bones?
I’m pretty sure I heard that it does.
It does not.
That’s good, because I like seltzer with a snack. Is snacking okay, or should I stick to three square meals?
There is some evidence suggesting a benefit from smaller meals spaced close together, in terms of total insulin requirements. There is also some evidence that eating earlier in the day is beneficial relative to packing in calories close to bedtime. But these matters are much less important than total daily diet quality, and quantity. Get those right, and almost any timing will be okay, although timing might make a good diet even better. Get quantity and/or quality wrong, and no time is a good time. What you eat matters more than when you eat it.
Listen, I am a very busy New Yorker and sometimes I eat the occasional PowerBar for lunch. Is that bad?
Many power bars have nutritional profiles similar to Snickers. Generally, power bars are closer to junk than to real food.
But they’re made of protein!
One of the great myths of modern diet is we all need more protein, but in this country almost all of us get more than we need. The satiety that comes from a concentrated protein source could come from a protein bar, or an egg, or a can of tuna, or yogurt, or nuts.
Okay, sure, but again: busy New Yorker. If I don’t have a can of tuna on hand, which protein bar should I eat?
If the bar, it should have a short list of recognizable ingredients; in other words, it should be made of real food. But try hard-boiling some eggs and keeping them handy; or a can of sardines. And stop obsessing about protein: We guarantee you’re getting more than enough.
What is the final verdict on eggs? Are high-cholesterol foods cleared to eat?
Yes. Most levels of high blood cholesterol are not from dietary cholesterol but from saturated and trans fats. Moderation is key. The average person gets most of her or his daily recommended cholesterol by eating just one egg a day.
We got this a bit wrong 30 years ago or so, because saturated fat and cholesterol go together in most foods. But we didn’t get it entirely wrong: The new thinking is that cholesterol is not a nutrient of concern for the typical American. That doesn’t mean it has been entirely exonerated, just that we are already eating it within the recommended range for the most part, and have more pressing concerns, like saturated fat, added sugars, high sodium, and all the rest.
How much protein do I actually need?
We need less than most of us get. A dose of about 1 gram of protein daily per kilogram (2.2 lbs) body weight is already generous in terms of the formal DRIs (Dietary Reference Intakes). So that would mean a man of almost 200 pounds would get more than enough protein from 90 grams daily. Just 3.5 ounces of salmon has nearly 30 grams, and a cup of cooked lentils has about 18 grams. That 200-pound man could easily eat twice that much, or more, in a single meal. So, getting enough protein is easy, which is why there is virtually no such thing as protein deficiency in the USA outside of hospital wards (where it is an effect, not a cause, of serious illness).
Do you have to take protein supplements to build muscle? They are gross, and I’d rather eat real food. But I also want to look like Wonder Woman.
(a) No. (b) Get a fancy bracelet. (c) Good luck! (Have you seen Gal Gadot?)
While we’re on the subject of Wonder Woman: What’s the best thing to eat before and after working out to lose weight and build muscle?
If your diet is wholesome and balanced overall, it almost certainly doesn’t matter. That said, for extremely long or intense workouts, there may be advantages to carbohydrate and protein prior, concentrated antioxidants after to help with muscle recovery. But none of this is relevant for a trip to the gym; this is for the Tour de France or a marathon. Otherwise, eat well over the course of each day, and distribute that eating around your workouts any way you like.
Which is a healthier diet: protein-rich, fat-rich, or fat-free?
They’re not mutually exclusive. You want moderate amounts of protein and fat in your diet. You want carbohydrates, too, which are in most foods but especially fruits, vegetables, grains, and legumes. What you don’t want is hyperprocessed food or a lot of animal products.
What about GMOs? I’ve heard foods with GMOs are really bad.
The foods themselves, no.
Genetic modification is just a method of producing something new, like an assembly line. The answer to whether assembly lines cause health problems is: “It depends what they’re making.” So, too, with GMO foods. It’s the foods that matter, not the process that produced them.
So I can just eat GMO food and not worry?
No. The chemicals used in growing them are a real concern. Glyphosate, the herbicide in Roundup, is likely carcinogenic and harmful in other ways. Furthermore, almost all of the foods currently produced using genetic engineering are useless at best and harmful at worst: “GMOs” are mostly present in junk food, which you want to avoid anyway.
So I should worry.
Since 1996, use of glyphosate has increased 15 times over; there’s a high probability of it showing up in our food.
Now the big question: Which foods will give me cancer?
Processed and cured meats are classified by the International Agency for Research on Cancer as a Group 1 carcinogenic. This doesn’t mean they’re as bad as tobacco, but it means the evidence about a link is comparably clear. Red meat is classified as Group 2A, which means it is “probably” carcinogenic. Needless to say this is a work in progress, but in general almost everyone in the United States would be better off eating less meat.
What if I barbecue it? That seems natural.
Charring food, meat especially, produces carcinogens; so does cooking carbohydrate at high temperature, which happens in the making of chips and some cereals.
This seems like bad news.
These are carcinogenic exposures, but then again, so is sunlight.
So it will kill me? Won’t kill me? Might kill me?
In general, the carcinogens in a reasonable diet make a very modest contribution to overall cancer risk, and don’t compare to something like smoking. A 2017 study by American Cancer Society researchers estimated that 40 percent of all cancer cases could be preventable, and nearly 20 percent of all cases are related to diet and physical inactivity.
Other studies put those figures even higher, but no matter what, if an optimal diet can prevent as many as one of every five cancer cases, and a crummy diet displaces the optimal diet, then the case could be made that a crummy diet of highly processed foods is highly carcinogenic. Our recommendation is: Don’t focus on specific carcinogens. Get your overall dietary pattern right, and your cancer risk will fall.
It sounds like cold cuts and hot dogs are really bad.
As is always the case with food being “bad” for you, it’s partly because of what you are eating, and partly because of what you aren’t eating. People who eat more processed meat are, presumably, eating fewer beans, fewer veggies. It is the overall dietary pattern that matters. But when you add in effects on the environment, and what it means to the animals involved, yeah, you don’t want to eat that too often.
How often is often?
We would go with … once or twice a month, not more. That said, if hot dogs are occasional; and pepperoni pizza is occasional; and cheeseburgers are occasional; and bacon is occasional … well, you get the idea. When all of the “occasionals” add up to more than occasional, then it no longer qualifies as occasional.
What about the “no-nitrate” meats? Are those healthier?
Nitrates have been identified as carcinogenic, and no-nitrate products should be nitrate free. Furthermore: Any product that comes with health claims should not be trusted. What’s not in a product matters, but what is in a product also matters. Sugar is “cholesterol free”! Trans fat is “sugar free”! So what?
Will we ever get lab-grown meat that’s good for us, and also won’t suck to cook and eat?
There are obvious ethical and environmental benefits of raising meat in a lab rather than the body of a living animal. It’s still early to know if there will be any nutritional benefits (or liabilities), and it’s also too early to know about resource use. Suppose lab-raised meat uses more water or food than “regular” meat? And, of course, it’s too early to say much about taste. What is true, is that we can be eating less meat, and better-raised meat, right now.
Is it really that horrible to have too much sodium? We need salt, right?
Too much salt is certainly bad for us, and most Americans eat too much salt. But here’s the thing: 70 percent of our salt comes to us in processed foods and restaurant meals that tend to be bad for us for many reasons. They are high in refined carbohydrate; added sugars; saturated fats; omega-6 oils; food chemicals, as well as sodium. By reducing intake of highly processed foods, and eating more whole, minimally processed foods, mostly plants, your sodium intake will go way down without focusing on sodium at all.
What about sugar? Is it bad for me if I eat it in moderation?
Sugar provides calories with no other nutrients — “empty” calories. It also goes quickly into the blood as blood sugar, where it triggers an insulin release. High levels of insulin help foster weight gain, and particularly fat around the middle, where it does the most harm. Perhaps more important, sugar and sweetness trigger appetite, so we simply tend to eat more when sugar is added to an ingredient list. The food industry knows this very well and routinely puts sugar into formulations to stimulate our appetites, and make us all eat more than we should. So, for many reasons, limiting intake of added sugar is very important to weight control.
How would you define sugar “moderation”?
Limit processed foods; and don’t eat foods with added sugar unless they are a dessert. Look out for sugar added to pasta sauce, salad dressings, even salty snacks. Calories from added sugar should be less than 10 percent of your daily total, and ideally, less than 5 percent.
What about sugar substitutes and artificial sweeteners?
Probably better than sugar, but almost certainly worse than a wholesome diet of foods naturally low in sugar, which then leaves room for a bit of sugar when something sweet is a treat.
Can I keep drinking diet soda? Is it terrible for me?
There’s no real evidence that it’s terrible, but no evidence it’s of any benefit either; it’s not even clear that it helps with weight control. Some recent evidence that artificial sweeteners may disrupt the microbiome and contribute to insulin resistance is reason for concern, and another argument to drink mostly water.
I feel smarter, but what happens when new information comes out, like, tomorrow? How can I stay up to date? It seems like the conventional wisdom on healthy diets changes all the time.
It doesn’t, and the definition of a healthy diet has been clear for some time. In fact, the basic theme of optimal eating — a diet made up mostly of whole, wholesome plant foods — has been clear to nutrition experts for generations. What does change all the time is the fads, fashions, marketing gimmicks, and hucksterism. How do you avoid the pitfalls of all that? Focus on foods, not nutrients. A diet may be higher or lower in total fat, or total carbohydrate, or total protein, and still be optimal. But a diet cannot be optimal if it is not made up mostly of some balanced combination of vegetables, fruits, whole grains, beans, legumes, nuts, seeds, and water. If you get the foods right, the nutrients sort themselves out. But if you focus on nutrients rather than foods, you quickly learn that there is more than one way to eat badly, and we Americans seem all too eager to try them all.
Bear in mind that humans evolved to eat a wide variety of diets, all over the world, from the Arctic to the tropics, desert, plains, mountains, all of which offer wildly different kinds of foods. But none of them “naturally” offer junk food or industrially produced animal products. If you bear that in mind, and eat a balanced diet of real food, you don’t have to worry about much else. It’s really quite simple.
Mark Bittman is the author of How to Cook Everything Vegetarian.
David L. Katz, MD, MPH, FACPM, FACP, FACLM is the founding director of Yale University’s Yale-Griffin Prevention Research Center, Immediate Past-President of the American College of Lifestyle Medicine, and founder/president of the True Health Initiative. He is the author of the forthcoming book The Truth About Food.
*A version of this article appears in the March 19, 2018, issue of New York Magazine. Subscribe Now!