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Dr. Robert D. Fusco, Medical Director    
Defensive Eating

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Doctor, what diet should I be on?

Every day in my office, patients ask me this important question. We will all eat thousands of meals in our lifetime. The food we eat must provide the nutrients we need for energy, bodily growth, maintenance, and repair. How can we be sure that these meals provide all the different nutrients we need for good health? In these health-conscious times, more and more individuals are becoming interested in proper nutrition. Many people want to improve their diet, but are often uncertain about which foods are really best. There is much confusion. Overwhelmed by conflicting advice, many Americans have simply thrown in the napkin on healthy eating.

Fortunately for most of us, a strict diet is not really necessary, but there is good evidence that we could all benefit by adopting better eating habits. We hope this article will help you choose a healthy diet.

Today's American Diet

From the dawn of agriculture, every civilization carefully cultivated cereal grains for food. Our ancestors' diet consisted mostly of whole grain breads, fruits and vegetables with only occasional meat and fat. Coarse bread from whole grain flour was called the "staff of life." This diet was high in dietary fiber ("roughage") and low in saturated fat and cholesterol.

As civilization progressed, eating habits changed. Advances in farming and food technology added many new foods to our diet. Modern refining methods discarded the plentiful fiber in whole grains to make white bread. Meats and pre-processed foods became more plentiful. This gradually introduced more fat and lowered the fiber content of our diet. In fact, over the last century, our consumption of fiber has been reduced to about one-third of what it used to be.

In today's fast-paced modern society, eating right is no longer a priority. Most children think that a balanced diet is a hamburger in one hand and french fries in the other. The typical American diet now consists mostly of pre-processed "convenience" foods and other junk foods. From macaroni and cheese to french fries and fried chicken, many of our favorite foods are low in fiber and high in saturated fat and cholesterol.

Our Food is Killing Us

America's love affair with high fat foods is now a habit of our culture. We eat more meat than anyone else -- over 200 pounds a year for every man, woman, and child. Unfortunately, this new attitude has taken its toll. Many of the ailments in our society - including obesity, coronary heart disease, and many forms of cancer - can be traced to our poor eating habits. If you eat an average American diet laden with meat, eggs, and butter, the arterial clogging that leads to heart disease is probably going on inside you and your family right now. Over half of us will die of heart disease and one in three will die of cancer. The National Cancer Institute estimates that over a third of all cancer deaths are now diet related. Scientists say that - after tobacco - food is now the number two killer in the United States.

There is good scientific evidence that many of our illnesses could be prevented if we all ate a better diet - one with more fiber and less fat. For example, researchers have found that the risk of colon cancer is four times lower in those who eat a high-fiber low-fat diet. It is estimated that if all Americans ate more fiber and less fat, colon cancer deaths in the United States could be markedly reduced --saving some 20,000 lives each year. Although over one million Americans die of heart disease each year, it is virtually unknown in many countries. And diet can help prevent it.

New Dietary Guidelines

So, no longer are nutritious eating recommendations reserved only for special groups like pregnant women and growing children. Healthy eating habits should be a routine for all people, for all ages, and for all time. A high-fiber, low-fat diet, together with certain vitamins and minerals, is the best diet to follow. That is the key: more fiber, less fat.

In practical terms, this diet means eating more fruit, vegetables, and whole-grain products, and much less food from animal sources - especially fatty meats, dairy products, eggs, and rich baked goods. It also means favoring fish and poultry over beef, lamb, and pork. [[daggerdbl]]

The National Institute of Health has developed a set of dietary guidelines to reduce the risk of cancer and heart disease. To make a commitment to a healthy diet, we suggest that you:

Eat a variety of foods. The nutrients we need can come from a wide range of foods not just from a few highly fortified foods or supplements. Different foods provide different nutrients. So, every day choose your favorite foods from these five groups - vegetables, fruits, whole-grain breads and cereals, low fat milk and milk products, and meats, poultry, eggs, and fish.

Choose a diet low in fat, saturated fat and cholesterol. You can have a balanced low fat diet by reading food labels, using fats and oils sparingly, eating lean meat and low fat dairy products. You should reduce your daily fat intake to 30 percent or less of total calories by eating foods that are low in cholesterol and saturated fats. Limit your cholesterol intake to 300 milligrams per day.

Eat an abundance of vegetables, fruits, pasta, rice, and whole grain breads and cereals and dried beans. These foods are rich in complex carbohydrates and fiber. Gradually increase your dietary fiber intake to at least 25 grams daily.

Drink plenty of water - at least six glasses daily. Most people don't think of water as food, but water is the most important of all nutrients. Adequate amounts of water help the body rid itself of metabolized wastes, firms the skin, and helps prevent kidney stones. Water helps your intestinal tract to handle the increased dietary fiber. Be sure to drink plenty of water when you increase your fiber intake.

If you drink, use alcoholic beverages only in moderation. They are high in calories and low in nutrients. Maintain a healthy body weight. Maintaining your ideal body weight is important for good health.Being too fat or too thin increases your chance of developing health problems. Most Americans are overweight, and if you are above your maximum body weight, you should reduce total calories so they do not exceed the amount needed to maintain ideal body weight. In general, you should eat about 12 to 14 calories per pound of ideal body weight. If you need to lose weight, a high-fiber low-fat diet is a good place to start, but the only proven way to safely lose weight permanently is to eat less and exercise more. A sensible weight reduction plan exploits this basic principle, while promoting balanced meals. If you are concerned about your weight, consult your doctor. He or she will be glad to recommend the best course of action for you. Finally, food alone cannot make you healthy. Lifestyle, heredity, environment, and health care are all important factors. But a diet based on these simple guidelines certainly helps you to be more healthy and stay that way.

Eat More Fiber...

Fiber is no fad. The benefits of dietary fiber have long been recognized. In ancient Greece, Hippocrates recommended the use of whole meal bread "for its salutary effects upon the bowels." Now almost 25 centuries later, fiber is back in the news. Newspapers, magazines, TV commercials, talk shows, and even cereal boxes regularly feature fiber. Many food companies now offer a wide array of high-fiber foods, and new products enter the market weekly. Fiber has become a household word, but few of us really understand the potential health benefits of fiber.

What is dietary fiber? First of all, it isn't a nutrient. It has no calories because it remains undigested after passing through your stomach and small intestine. Yet its bulk contributes to a feeling of fullness and it stimulates the muscles in your intestine so they maintain their tone. Fiber's ability to absorb water make it an excellent natural laxative. It increases the bulk of the stool and is essential for good bowel regularity and stool consistency. Dietary fiber is only found in plant material such as whole grains, fruits, vegetables, beans, nuts, and seeds.

A One-Two Punch

Fiber packs a one-two disease-fighting punch. The top two killers in the United States are heart disease and cancer, and fiber may help prevent both. There is good evidence that a diet high in dietary fiber can reduce your risk of breast and colorectal cancer and help lower your blood cholesterol level. Fiber also holds great potential to help prevent or treat other chronic diseases of our society such as diabetes, diverticulosis, irritable bowel syndrome, constipation, hemorrhoids, and hiatal hernia. Fiber is a near miraculous protector of the intestinal tract and improves GI problems across the board. As an added advantage, foods high in fiber may also help with weight control. That's because high-fiber foods can help supply a hearty feeling of fullness without a calorie overload. They are lower in calories, fill you up, and take longer to chew.

Is All Fiber the Same?

Actually, there are two kinds of plant fiber - insoluble and soluble. Together they make up what is called total dietary fiber, but these two forms of fiber function differently in the body. Insoluble fiber was the first trendy fiber and is found in the indigestible stalks and peels of fruits and vegetables and husks of whole grains. It travels through your body virtually undigested. Insoluble fiber doesn't dissolve in water but acts like a sponge, absorbing it. This bulking action helps soften the waste and move it quickly out of the body. Because it is a natural laxative, insoluble fiber is effective in relieving symptoms of constipation, diverticulitis, irritable bowel syndrome and hemorrhoids.

More importantly, increasing medical evidence shows that insoluble fiber may help guard against breast cancer, colon polyps and colon cancer. It's now thought that this type of fiber not only speeds up the passage of normal materials through your intestine, but also speeds up the elimination of cancer-causing agents within the stool. For instance, some bacteria may produce poisons that damage the delicate cells lining the intestine. The higher speed of passage created by insoluble fiber may help to stop this damage. Wheat and corn bran, brown rice, and bananas are the most concentrated form of insoluble fiber, but all whole grains and many fruits and vegetables also contain large quantities.

When it comes to lowering cholesterol, soluble fiber is the hero. Soluble fiber dissolves to form a gummy gel when it mixes with water in your digestive tract. This gel slows the absorption of carbohydrates, which helps stabilize blood sugar levels and also lowers your blood cholesterol. Because it gives a feeling of fullness for a longer period of time, soluble fiber helps control appetite and enhances weight-control. Dried beans (kidney, lima, navy and pinto), whole oats, and oat bran are the most concentrated forms of soluble fiber. Other sources include prunes, apples, oranges, pears, lentils, sweet potatoes, carrots, zucchini, okra, cauliflower, corn, barley, peas and psyllium (Metamucil).

You don't need to memorize all of this. Just remember that most fruits, vegetables, and grain products contain both insoluble and soluble fiber. Eating a wide variety of these foods can help you get your fair share of both forms of fiber.

How Much Fiber Do I Need?

More than your getting now.... Despite fiber's advantages, Americans at present only consume half as much fiber as they should. In a recent national survey less than 10 percent of the public had eaten the amount of fruit and vegetables needed to meet minimum dietary guidelines. More than 80 percent did not consume any high-fiber foods on the day of the interview. These results are similar to surveys done in the 1980's suggesting there has been no improvement over the past decade. Extensive public education is needed.

As an average American, you now consume a paltry 12 grams of dietary fiber a day. That's not enough. The National Cancer Institute recommends eating foods that provide the body with at least 25 grams of dietary fiber per day. If you are the average eater, this means that you should more than double your current intake of fiber.

How to Add More Fiber

Unless you are sitting under the apple tree, fiber isn't likely to simply drop into your lap. You will have to look for it. But once you actually begin to look, finding fiber is easy enough: it is found in all plant foods. That includes fruits like strawberries, raspberries, cantaloupe, pineapple, bananas, apples; and vegetables like peas, beets, corn, cabbage, broccoli, and potatoes. Dried beans like lentils, pinto beans, black beans, and navy beans are among the best fiber sources.

Be a little adventurous. Try some of those unfamiliar vegetables that you always see at your grocery, but never were brave enough to buy - like kale, turnips, and parsnips. Ask your grocer about what is fresh and in season. Don't be fooled by appearance, however. High-fiber foods cannot always be identified by their texture. For example, celery and lettuce are not good sources of fiber, but bananas are.

Whole-grain breads, whole grain breakfast cereals, and whole grain pastas are also good sources of fiber, as are seeds, nuts, and popcorn. To help boost your fiber intake, try using whole grain breads for sandwiches and toast. Whole wheat bread is the healthiest form of bread because it contains the natural fiber, vitamins, and minerals present in the wheat germ. There's virtually no fiber to be found in ordinary white bread, meat, and dairy products. (Two of my favorite whole grain breads are the Brownberry Bran'nola whole wheat bread and the multi-grain bread which is sold at the Ultimate Pastry Shop in Sewickley.)

Bran, the outer coating of cereal grains, is a highly concentrated source of fiber. At breakfast, sprinkle a tablespoon of unprocessed bran over your hot or cold cereal. Better yet, switch to a high fiber breakfast cereal. Cook with brown rice. Its natural bran covering is a better source of fiber than white rice.

Vegetables and whole fruits, especially those with edible skins are high in fiber. (Choose fresh fruit or vegetables rather than juice. The amount of fiber in juice is insignificant when compared to whole fruit.) Eat skin and membranes of clean fruit and vegetables, such as apples, peaches, tomatoes and carrots. Peel a grapefruit and snack on it like an orange, or substitute a baked potato with skin for mashed. Although fresh fruits and vegetables are the ideal choice, there is nothing wrong with the frozen variety.

To attain the recommended daily intake, we suggest that you eat day you eat 3 or more servings vegetables, 3 or more of fruit, and at least 6 of grain products. Although this sounds like a lot, the servings are actually quite small--one slice of whole wheat bread, for example, or one-half cup of fruits or vegetables. Fortunately, cooking has no effect on fiber content; one can choose among a great variety of foods as well as methods of preparation.

Be Full of Beans

Unknown to most people, dry beans are perhaps one of nature's near perfect foods. They're tasty, high-fiber low-fat cholesterol-reducing, and loaded with vitamins and minerals. Beans supply a substantial nutritional return for the calories. Eaten in combination with grains, nuts, seeds, or dairy products, beans equal the protein of meats--with much less fat. Beans contain no cholesterol and they contain the type of soluble fiber found in oat bran, which reduces serum cholesterol. Beans are an excellent choice in high-fiber low-fat diet. They are more economical than meat, fish, poultry, and even eggs. They keep indefinitely in your pantry without refrigeration and contain no additives or preservatives.

We recommend starting with dried beans rather than canned. The former are less expensive, lower in sodium, and simple to prepare. However, in a pinch you can substitute canned beans for dried. One 15-ounce can of beans equals about one cup of dried beans. Most dried beans double in volume when cooked. Drain and rinse canned beans before using. It's always cheaper to cook from scratch, but if you are busy, try Bean Cuisine pre-packaged soup mixes. Mesa Maize and Bean and Ultima Pasta & Fagioli are my favorites.

Unfortunately, beans cause some people indigestion and gas. Oligosaccharides are the culprits. These are the complex sugars in beans that can't be digested by your body. When these undigested sugars reach the colon, they are fermented by the bacteria that normally live in the colon. This fermentation often results in gas-the same way fermenting grapes make champagne. To reduce this problem, presoak beans before cooking. Soak each cup of beans in four cups of cold water for at least six hours. If soaking overnight, refrigerate to prevent fermentation. Don't cook beans in the same water in which you soaked them. Changing the water cuts the amount of indigestible sugars in the beans. Be sure to throw the soaking water out, rinse the beans again, and use fresh water for cooking. Some of the vitamins and minerals will go down the drain, but you can't have everything.

When cooking, simmer gently to prevent breaking skins. You can add a teaspoonful of canola oil to prevent foaming during cooking. Add tomatoes, wine, lemon juice, vinegar, or any other acid substance at the end of cooking time since acid toughens the skin and delays softening of the beans. Beans are done when soft, not chewy. One cup of dried beans or peas yields about two or three cups cooked. If beans are served as salads, serve them at room temperature or only slightly chilled, as flavor diminishes when beans are very cold. Cooked beans can be refrigerated for up to five days or frozen for up to six months. Dried beans can also be cooked in the microwave. One quick method: Soak the beans conventionally overnight, then cook in fresh water at full power for 8-10 minutes, or until boiling. Continue to cook at 50% power 15-20 minutes or until tender.

Fiber Supplements

In general, it's best to get your fiber from the grocery, not the pharmacy. However, for some people, just adding high-fiber foods to the diet does not provide enough intake of soluble fiber. For these people, the doctor or dietitian may advise the use of a soluble fiber diet supplement. These non-prescription supplements provide highly concentrated sources of fiber and can complement a high-fiber, low-fat nutrition plan.

The one most often recommended is powdered psyllium seed (Metamucil, Hydrocil, FiberAll). Psyllium is a grain grown in India that contains about 10 times as much soluble fiber per ounce as oat bran. A teaspoonful or two of powdered psyllium seed stirred into a glass of juice first thing in the morning has been found by many to be the answer to a sluggish bowel. It is well tolerated and has few side effects. In fact, you could use psyllium every day of your life without ever becoming laxative-dependent. And research has shown that taking two or three doses daily can lower your blood cholesterol level up to 15 percent!

These supplements do exactly what they say--they supplement the diet, but they do not take the place of a healthy diet that contains fiber-rich foods. A natural diet is not only healthy but it can also be interesting to eat, and it can be more economical than relying on commercial fiber diet supplements.

Can I Eat Too Much Fiber?

Yes. While there is some evidence that a diet very high in fiber can interfere with absorption of some vitamins and minerals, this is not a problem unless you exceed 50 grams of fiber per day which is not very likely.

But remember the musical saying: "Beans, beans, the musical fruit, the more you eat the more you toot."? It describes one troublesome property of fiber - its ability to be fermented by the bacteria in your large intestine. Unfortunately, this fermentation produces gas that imparts a bloated feeling. So, most people will experience some additional intestinal gas and bloating when they first add extra fiber to their diet.

If you experience this problem, don't be discouraged. Simply allow your body time to adjust to the increased fiber. It is best to build up your body's tolerance gradually. Don't overdo it. Eat small servings initially, then slowly increase your intake. The extra gas usually disappears in six to eight weeks, when the intestine gets used to the extra bulk. So, don't rush into a high-fiber diet. Eat a new high-fiber food two or three times a week, for a period of two or three weeks. After that time, you will be able to add another high-fiber food without experiencing any difficulties. Then, on a regular basis, you can continue to increase your fiber intake until you reach the recommended intake levels.

If you have been told by your doctor that you have severe diverticulosis or have ever been treated for diverticulitis, it is recommended that you avoid seeds, nuts, and whole kernel corn in your diet. Other forms of fiber are acceptable.

Eat Less Fat

Most people eat fatty foods because they like them, not because they need them. It is an acquired taste in our culture. We've learned to prefer cuts of meat heavily marbled with fat. Fats are responsible for many of the flavors, aromas, and textures in food. Fats are what make ice cream creamy and cakes and cookies light. The pleasurable feeling of swallowing food often comes from fat. Simply put, fat creates sensational "mouthfeel," a word coined by nutritionists to describe the moment when your tongue makes contact with a cheeseburger. Fat makes meat seem more tender and flavorful and is extensively used in our American and European style of cooking. Frying foods and serving them with gravies and sauces adds even more fat to the foods. Eating high fat foods has become our tradition.

Of the total calories we eat, over 40 percent now consists of fat. The average American now consumes about 80 to 100 grams of fat daily -- that's almost equivalent to a stick of butter! This is too much. Scientists have long known that animal fat is a cancer risk and a heart stopper. The American Heart Association now recommends that less than 30 percent of our calories come from fat.

Are There Different Types of Fat?

Yes. There are several different types of fat: saturated, poly-unsaturated, and mono-unsaturated. The roles of these different types of fats and their effect on blood cholesterol have been the subject of much scientific study in the last 30 years and only recently has a clear picture emerged.

Saturated fats are found in meats and dairy products such as whole milk, cream, ice cream, cheese, and butter. It is also found in lard, animal shortenings and in tropical oils such as palm, palm kernel, and coconut oils. Saturated fats are found in the pre-processed foods made with these ingredients. These saturated fats tend to raise blood cholesterol levels, clog your arteries, and raise your risk of heart disease and certain types of cancer.

Poly-unsaturated fats are mostly found in margarine and oils made from sunflower, safflower, corn and soybean oils. They are found in fish and fish oils. They tend to lower cholesterol and reduce your risk of heart disease.

Mono-unsaturated fats mostly occur in olives and olive oil and canola oils (Puritan and others). If used in place of saturated fats, they also help reduce cholesterol and reduce your risk of heart disease. Scientists agree that cutting back on total fat is probably one of the healthiest changes you can make in your eating habits. But, it's most important to reduce the intake of saturated fats, which are most associated with elevated blood cholesterol levels.

Should I Eat Less Cholesterol?

Yes, but many people mistakenly believe that the best way to lower their blood cholesterol is by eating less cholesterol in their diet. This is not totally true. Weeding out the cholesterol in your diet is less useful than banishing saturated fat. This is because the excess saturated fat you eat raises your blood cholesterol more than the extra cholesterol you eat. Foods can have no cholesteol yet still be dangerously high in fat. So, while reducing the amount of cholesterol in your diet is clearly important, eating less saturated fat is the best way to lower your blood cholesterol. Focus on the saturated fat, not cholesterol. Don't be fooled by misleading claims. A food product can be labeled "No cholesterol" and still be high in saturated fat - which will raise your blood cholesterol. Real the label. Avoid foods containing coconut, palm oil, and palm kernel oil. They are especially high in saturated fat. Your best choice is a product that contains more polyunsaturated fat than saturated fat. Poly-unsaturated fat will lower your blood cholesterol. You should try to replace the saturated fats in your diet with the poly-unsaturated and mono-unsaturated fats, but still keep the total daily calorie intake from fat to less than 30 percent of your diet. Remember, though, that all fats are a rich source of calories.

The recommended eating pattern is to eat:

+ an average of 30 percent of calories

or less from total fat

+ with less than 10 percent of calories from saturated fat

+ and less than 300 mg a day of dietary cholesterol.

Note: One caution, school-age children who are actively growing whose diets are low in fat may miss essential vitamins. Their parents should make sure they get high-nutrient foods in their diets. They need extra iron, vitamins, and calories. Children under 2 should not be on a low-fat diet.

How To Eat Less Fat

Don't make meat the star of your plate.

Give it a supporting role instead. Eaten in moderation, lean red meat can actually complement a low-fat diet. You don't have to give up meat altogether; instead use a smaller amount for flavor and texture while substituting lower-fat foods for bulk. This is a common practice in lands where beef, pork, and chicken are less abundant than they are in the United States. A healthful serving of meat is about 3 to 4 ounces which is about the size of a deck of playing cards. This contains about 6 grams of fat. A good rule of thumb is no more than 4 servings per week.

To "stretch" your portions, slice meat into thin strips, then fan out on the plate and serve with generous portions of vegetables. Or serve on a bed of wild greens and fresh herbs and drizzle with balsamic vinegar. Serve a stir-fry over a bed of rice.

Look for lean cuts of red meat.

When buying beef, check the label or ask your butcher what grade meat you're buying. Ask for "select" which is the leanest. "Choice" is somewhat higher in fat, and "prime" is the fattest. Even the leanest cut can use some pruning. Trim all visible fat from meat before cooking. (Hint: Chill meat in a freezer for 20 minutes before trimming. Blasted with cold air, fat quickly hardens and slices off easily)

Leaner cuts of meat tend to be tougher and slightly less flavorful than other grades. To tenderize and add flavor, marinate lean cuts like London broil or flank steak in the refrigerator overnight. One easy way to do this is to use a roasting bag. Fruit juices and wines make excellent marinades. Try red wine and water, lemon juice, orange juice or white wine. Add fresh herbs or garlic. Instead of lean ground hamburger which is still 15 percent fat, select several pounds of London broil or top round and ask your butcher to trim off all the fat and grind it for you. The resulting ground beef is as low as 5 percent fat. When browning meat, remember to drain off the fat. Ask your grocer about Healthy Choice Extra Lean Low Fat Ground Beef which contains only 4 grams of fat per four ounces vs. 17 grams for regular lean ground beef. This new product contains an extract of oats and is a little less juicy than regular ground beef, but it is perfect for use in chili and other ground beef recipes.

Use more fish and lean poultry.

Substitute fish and skinless poultry for red meat in main dishes several times a week. By substituting two 3-ounce servings of halibut for two 3-ounce servings of pork spareribs, you will be eliminating the amount of fat found in 12 pats of butter. A skinless chicken (or turkey) breast is lowest in fat of all the chicken parts. White meat has less fat than dark meat. When making meat loaf or burgers, consider ground skinless turkey breast, not regular ground turkey. Three ounces of ground turkey breast has a mere 3 grams of fat, while regular ground turkey (which often include the dark meat and skin) has 12 grams of fat. Some butchers may balk at grinding small orders of turkey breast, since the equipment has to be cleaned between different kinds of meat. So purchase a large quantity at one time and store the frozen turkey breast in one pound packages.

Limit the amount of regular lunch meat and frankfurters you eat. Wean your family away from high-fat cured meats by using low-fat turkey or chicken hot dogs instead of regular varieties. Use turkey breast, low-fat ham, tuna, or chicken salad instead of bologna and other sandwich meats. Turkey bacon has half the fat of pork bacon.

Go easy on whole eggs.

If you like eggs, limit them to three or four whole eggs per week. Avoid egg yolks when possible. Since only the yolks contain fat and cholesterol, you can use egg whites freely. For example, you can make scrambled eggs using one whole egg and two or three whites. In recipes that include margarine, vegetable shortening or oil, simply substitute 2 egg whites for each whole egg. If the resulting product is a little tough, next time try adding an extra teaspoon of cannola oil. (About the only time this substitution doen't work is in pound cake or flour-less cake.) If the egg yolk is the only source of fat in the recipe, substitute one egg white and one teaspoon of cannola oil for each yolk. Or when baking, try using an egg substitute like Fleishmann's Eggbeaters. One whole egg has over 200 milligrams of cholesterol and about 6 grams of fat while 1/4 cup of egg substitute (equilavent to 1 egg) has only 1 milligram of cholesterol and 0 grams of fat.

Limit your use of butter.

The taste of butter is very appealing, but you pay a very high price in saturated fat and cholesterol. You don't have to give up butter completely, but you should learn to use it less often and more sparingly. Save butter for special occasions like a fine restaurant. Whenever possible, substitute margarine. But, read margarine labels. One myth about margarine is that it is less fattening than butter. In fact, margaine and butter contain the same amount of calories per serving -- all of them from fat. However, because it's a vegetable product, margarine has no cholesterol and little saturated fat. Brands of margarine do differ, thought, in the amount and type of saturated fat they contain.

So compare the labels, and choose margarines lowest in saturated fat. Stay away from any margarines that are made of lard, coconut oil, or palm oil. Buy one with liquid polyunsaturated oil (corn, sunflower, soybean, or safflower oil) as the first ingredient like Fleishmann's Light or Promise. Tub margarine may be a better choice than stick margarine. If you are watching your weight, look for a low calorie spread such as Country Crock, Weight Watcher's Reduced Calorie Margarine, or Promise Light. These contain more water and even less fat than regular margaines do. (But don't fry or sauté with diet margarines since the water will cause spattering.)

Limit your use of other fats and oils.

Bake, roast, or broil meat, poultry, or fish. Don't fry. To cut down on the need for oil in cooking, use a vegetable cooking spray and pans with a non-stick surface. Bake , steam, or stir-fry vegetables in only a small amount of oil. You can even trim the fat from stir-frying by frying in juice rather than oil. Some tasty options are apple, pineapple, or orange juice and pear or apricot nectar. Since the juice evaporates, you need to keep adding more. But the fat content of juice is negligible, and you're saving 14 grams of fat for every tablespoon of oil you forgo.

Don't deep-fry. When cooking, substitute liquid vegetable oil for solid shortening, and replace butter with margarine. Avoid saturated fats such as lard, palm, palm kernel or coconut oil, whenever possible. Use olive oil, Puritan canola oil, safflower, or corn oil. Avoid creamy sauces such as hollandaise or béarnaise sauces. If you do want to give vegetables a little added flavor, try herbs, spices, lemon juice, or non-fat yogurt toppings instead. Limit how much oil-based or creamy salad dressing you use. Substitute oil-free salad dressing, lemon juice, or flavored vinegar. Try Seven Seas Free, Healthy Sensation! Salad Dressing, or Hidden Valley Ranch Take Heart. (My favorite is Seven Seas Free Red Wine Vinegar Non-fat Salad Dressing.) Try applesauce instead of oil/butter when baking brownies; it gives a rich moist body. [[daggerdbl]]

Use low-fat milk products.

Based on fat content, there are four types of milk in your grocery store. Most of us now drink whole milk which contains about 3% fat. The switch to 2% milk is painless and will help cut your fat intake. In fact, most people find regular milk "too thick" after they have become used to 2% milk. You might even find later that you also enjoy 1% low-fat milk. Skim milk contains almost no fat, but most individuals dislike its watery texture and lack of taste. However, many products made from skim milk are acceptable and very low in fat. For instance, buttermilk made from skim-milk contains almost no fat. Choose mozzarella cheese which is made from skim milk and low in fat. Avoid Cheddar and Brie.

Avoid cream and half-and-half. Both are very high in saturated fat. Surprisingly so are some non-dairy creamers. Some of these products are advertised as low in cholesterol. What they don't tell you is that your body will use the saturated fat in the creamer to make excess cholesterol. When selecting a non-dairy creamer, look for one made from polyunsaturated fat (soybean, corn, safflower, or sunflower oil) and avoid tropical saturated oils like coconut, palm, and palm kernel.

Take the fat out of creamed soups. Substitute canned evaporated skim milk for cream when making sauces or creamed soups (cream mushroom, chicken, or potato). It is a flavorful substitute for cream and has fewer calories and almost no fat.

Try low-fat or no-fat yogurt.

Although yogurt has been used for centuries, it has only recently become popular in the United States. In fact, yogurt's current popularity is nothing short of phenomenal. One good reason for its popularity is public awareness of its nutritional value. Yogurt is easily digested and high in calcium. It can be low in fat and calories - but only if you select the right kind. Non-fat yogurt is better for you than low-fat, and both are better than yogurt made from whole milk. Most supermarkets offer all varieties, so read the labels carefully before you buy. Dannon Light is one non-fat yogurt that also is sugar-free. It contains no fat and is only 100 calories per 8 oz serving. Yogurt can be used in place of high-fat salad dressings, or as a substitute for butter or sour cream on baked potatoes. Try it on bread and toast combined with crushed fruit or mix it with fresh herbs and use it as a dip with raw vegetables.

Avoiding fat and excess calories doesn't mean you have to skip dessert. Instead of regular ice cream, try the FatFree and Non-Fat frozen yogurt selections at Baskin Robbins. They are delicious. Baskin Robbin's Truly Free(TM) non-fat frozen yogurt is also sugar-free. My favorite was chocolate mint. This means you could enjoy a creamy delicious frozen dessert with no fat and only 100 calories per 1/2 cup serving.

Try non fat foods.

Those of us who just can't seem to give up ice cream, cheese, mayonnaise and other foods rich in fat--even though we know they're not good for us--now have some less caloric choices. Several companies are developing imitation fats, which can reduce calories by up to one-half in certain products and contain no cholesterol. Currently, three companies are working on substitute fats. The NutraSweet Co. recently made Simplesse available in frozen desserts. Two others, Kraft General Foods and Proctor and Gamble, are seeking approval to market their versions of imitation fat. Simplesse is made from the natural proteins in egg whites and skim milk, giving it a creamy texture. However, it congeals when heated and cannot be used in cooking. Simplesse contains fewer calories than real fat. Since the average American consumes over 40 percent of total calories from fat, an imitation fat may greatly reduce fat consumption for many of us. Imitation fat has found its way into foods like yogurt, cheese, mayonnaise, sour cream and salad dressings. If imitation fat that can be used in cooking is approved, fat-free potato chips, French fries and cookies may appear on supermarket shelves--giving many of us some room to indulge guilt-free! But remember: imitation fat still won't allow us to ignore the general guidelines for a healthy diet.

More non-fat foods are appearing in your grocery daily. Most are delicious and hard to tell from their "fatty" counterparts. Established brands like Eggbeaters have been around a while. Now substitute fats such as Simplesse are adding more choices to your menu. Try making potato or pasta salad with Kraft Free Non-fat Miracle Whip dressing and you can save over 20 grams of fat per serving. Or try it with water-packed tuna to make a tuna salad sandwich on whole wheat bread. Light `n Lively Free Non-fat Sour Cream over baked potatoes tastes great. Some other examples would include Entenmann's baked goods, Special K Frozen Waffles, Light `n Lively Free Non-fat Cottage cheese, non-fat ricotta cheese, frozen soft pretzels, Pritikin spaghetti sauces. Weight Watcher's salad dressings are non-fat and come in individual single serve packs which are great for taking to work or eating out.

Try the new TV Dinners.

When you're in a hurry, consider one of the new low-fat TV dinners. Contrary to the fat-laden TV dinners of the past, the new trend in frozen dinners is the "healthy meal." They are low in total and saturated fat and, of course, low in calories. Look for product lines such as "Eating Right," "Healthy Choice," "Lean Cuisine," and "Le Menu Healthy." Read the label and pick a meal you like with less than 10 grams of fat per serving. Two of my favorites are Healthy Choice Rigatoni in Meat Sauce and Lean Cuisine Glazed Chicken.

Unfortunately, these new selections are low-fat, but often still low in fiber. In fact, there is so little fiber in these meals that most manufacturers don't even list it on the label. To supplement these simple meals, add side dishes of whole grains, fresh fruit, and vegetables. A salad or steamed fresh broccoli with low-fat dressing would provide extra vitamins, minerals, and missing fiber without adding too much fat or too many calories. Add a whole grain roll and low-calorie margarine.

When dining out

Eating out has become an American pastime. With many husbands and wives both working and their busy schedules, many couples dine out several times per week. But this does not necessarily mean that you have to drop your commitment to low fat high fiber foods. According to the National Restaurant Association, seven out of ten adults now restrict their fat intake, which means that ignoring nutritional concerns has become as bad for the restaurant's business as it is for the patron's health. For people who still love to eat for the sheer joy of it, the good news is that the increasing vigilance regarding fat has forced chefs to turn to more varied and subtle flavorings. Most menus now include delicious low fat entrees.

But, if you don't see what you want on the menu, you can ask for modifications. Don't be shy. Good waiters and waitresses now see themselves as the diner's emissary to the kitchen. When ordering your meal, tell them that you are watching your fat intake. They often know as much as the chef about the dishes they serve and can make special suggestions. Don't be intimidated by the menu, the atmostphere, your waiter, or waitress. Remember you are the patron. Insist that food be served the way you want it. Most waiters say they would rather deal with a lot of questions than a dissatisfied customer.

Always room for Dessert

When its time for dessert, most of us simply can't resist the temptation. Even if we are ready to explode, we can't call the meal complete without something sweet and sinful.

If it's an infrequent fling, enjoy. But budget your calories, fat, and cholesterol in the days before and after to make up for it. Remember, when the American Heart Association tells you that no more than 30 percent of your calories should come from fat, they're referring go your overall diet. You needn't banish your favorite dessert. Just have a little less of it. If you really want that cheesecake, order it--but share it.

If you have dessert often, ask about special offerings. Most restaurants make an effort to provide at least one low fat choice. Look for a fresh fruit or berries with a liquer-based sauce. Ask about a low fat sorbet or yogurt. My favorite is a black raspberry sorbet with fresh berries and a spash of Italian dessert wine. Choose a dessert like a cobbler or crisp over a pie, cake, or torte. The latter have crusts laden with butter or lard and are often crowned with rich creams or custards.

How about fast food?

Special request make sense in an elegant restaurant. But even family-style chain restaurants are now willing to lean over backwards to please a picky eater. Nearly 90% of chain restaurnants have switched to vegetable oil for fying. Most list some variety of light fare and offer broiled or grilled entrées. Salad bars are healthy if you avoid offerings drowned in mayonnaise, creamy dressings, and oil-soaked croutons. Most offer a low-fat salad dressing.

Vitamins and Minerals

There is a little bit of controversy here. If you eat properly, most nutritionists would say that you do not need to take vitamin pill supplements. You can get all the vitamins you need through a balanced diet alone -- and that supplements won't make up for already poor eating habits. Vitamins pills won't give you energy. You get energy (measured in calories) from the carbohydrates, fats, and proteins in your diet. If you're taking vitamins to ward off fatigue, you'll benefit only if you were vitamin-deficient to begin with--and few Americans qualify. So be skeptical of the words energy or vitality on packages of supplements. If vitamins alone provided energy, popping megadoses would make you fat. They don't.

But scientists are now learning that some vitamins may play a more important role in disease prevention than we thought.... particularly vitamin A (beta carotene), vitamin C, and vitamin E. Taking one simple multivitamin supplement containing these each day won't hurt and may be more beneficial than previously realized. If it makes you feel better, take supplements for extra "insurance." The only time you can run into trouble is if you start using vitamin pills as a substitute for sensible eating or if you take "megadoses" of vitamins.

Calcium is a different story. Many people assume their bones stop growing when they become adults. Not so. The 206 bones in your skeleton forms a dynamic living tissue that continuously dissolves and reforms in a process known as remodeling. By your first birthday, your entire skeleton has been remodeled. By the time you reach age 35, your skeleton has reached its peak bone mass and your bones are most dense and strong. Then things start going downhill. After your mid-thirties, your bones start losing more substance than they create and your bone mass begins dropping. Your bones can become more porous and fragile - a condition called osteoporosis. More fragile bones means more broken bones, especially in women who have smaller bones to being with.

Lack of adequate calcium in your diet can increase your risk of developing osteoporosis later in life. Calcium is the most abundant mineral in your body, but your body can't manufacture it. You have to get all the calcium you need from your food. The problem begins when teenagers switch from milk to soft drinks. On any given day, most of us do not consume the recommended minimum amount of calcium in our diet. Bones are your calcium "bank." If you don't get enough calcium from your diet, your body takes what it needs from your bones. Little by little, the body taps into the skeleton's calcium supplies causing more bone loss.

High calcium intake today prevents fractures tomorrow. That's why experts recommend that most Americans consume at least 1000 milligrams of calcium daily; and women past menopause should get 1500 milligrams. Sounds easy but the shocking fact is that over half of men and 85 percent of women don't attain anything near those levels. In one recent study of teenage girls, over two-thirds did not meet the minimum calcium intake per day.

Dairy products such as milk, yogurt, cheese, ice milk, and pudding are storehouses of calcium. We recommend adults eat at least 2 servings of dairy products daily, but the low-fat version is best. Adolescents need 4 servings per day. Substitute skim or low-fat milk (1%) for whole milk. Skim milk supplies about 300 milligram of calcium per cup, the same amount of calcium as whole milk. Try yogurt, cottage cheese, or mozzarella cheese made from skim milk. My favorite is low fat cottage cheese with canned peaches or fresh strawberries. A cup of low-fat yogurt supplies 415 milligrams of calcium. Non-fat frozen yogurt is a delicious way to add calcium. Other sources of calcium are green leafy vegetables (kale, collard greens, mustard greens), broccoli, cooked beans, sardines, tuna, figs, nuts, and sunflower seeds.

Water: The body's forgotten nutrient

Poor water gets no respect. It is the most important of all nutrients, but most people don't think of water as food. You can go without food for five weeks, but without water, you'd be dead in five days. Water is essential to every aspect of physical well-being. It makes up about two-thirds of an adult's body. Water helps maintain normal function in all body systems including digestion, breathing, circulation, and muscle movement. Water carries nutrients to the body's cells and help eliminate wastes. The body's need for water is unyielding.

Yet, hardly anyone drinks enough. Although exact water needs for each person differ, experts estimate that all adults should drink a minimum of eight 8-ounce glasses of water every day. The estimates go up from there. Actually each of us should drink a minimum of one half ounce for each pound of body weight, which means a 160-pound person would need 80 ounces, or 10 eight-ounce glasses daily. (HINT: Divide your weight in pounds by 16 to determine how many 8-ounce glasses of water you should drink daily) Those exposed to high heat or who experience high levels of physical activity require even more. But most surveys put two-thirds of Americans at least a quart short.

If you often feel lethargic or have frequent headaches, it might be a symptom of early dehydration. One way to tell if you are drinking enough water is to look at your urine. It should always be pale yellow and take at least 10 seconds to empty your bladder. If you only make two or three trips to the bathroom each day and you produce only a trickle of dark yellow cloudy urine, your kidneys are struggling to reduce water loss by concentrating your urine. This means that you are dehydrated and need much more water.

Don't wait for thirst which is actually a sign of mild dehydration. To increase your water intake, have two cups when you get up in early morning. Keep a water container on your desk and add two more glasses about an hour before lunch and dinner. Have a large glass of water with lunch and dinner. When dining out, ask for refills. To make it more interesting, request a fancy goblet and drink it ice cold with a fresh slice of lemon. Always drink water before, during, and after you exercise.

What about other beverages? Not all drinks count, but club soda, sugar-free caffeine-free beverages, 100% fruit juices, low sodium vegetable juices, and low-fat milk can be substituted. Avoid too much caffeine. It acts like a diuretic and causes higher urinary water losses which worsen the problem. Avoid large amounts of sugary soft drinks which only add empty calories that could better be invested in nutritious foods. Avoid excessive beer, wine, and liquor. Above all, don't take water for granted.

Shopping

Now that you are serious about a healthier diet, grocery shopping may require a little more of your time and thought. But, don't set yourself up for failure by racing all over town trying to find special ingredients. Today we have more high-fiber low-fat options than ever before and most large grocery stores have all you need. The most important thing you can do is to read the label on every food you buy.

It is easier to look at the amount of fat per serving. As a rule, 3 grams of fat per serving is low, and more than 10 is high. Read the labels for terms that mean cholesterol or saturated fat: egg and egg yolk solids, whole-milk solids, palm, palm kernel, or coconut oils, imitation or milk chocolate, shortening, hydrogenated or hardened oils, lard, butter, suet, and animal by-products.

While we are on the subject of suspicious labels, watch out for "cholesterol-free." The Food and Drug Administration (FDA) is beginning to crack down on deceptive labeling practices, such as foods whose labels say cholesterol-free but fail to tell you about the high saturated fat content. Supermarket shelves are filled with many fat-laden foods like chips and cookies all sporting "cholesterol-free" flags. Such labels are confusing, if not outright misleading; eating a bag of cholesterol-free potato chips still contributes to high blood cholesterol. There are no standards by law. Fortunately, the FDA is working toward less misleading product guidelines. Until new regulations are in place, the consumer must be the watchdog. Read labels carefully and ask questions. Remember, a diet to lower blood cholesterol is not the same as a low-cholesterol diet. This difference is critical. Foods low in cholesterol are not necessarily low in fat. Concentrate on lowering the amount of fat you eat.

You should also be careful when checking for fiber content. If grams of fiber per serving do not appear on the list, the fiber content may be negligible. Read the labels carefully on bread, breakfast cereals and other grain foods. For instance, the FDA has standards for two main types of bread - whole wheat and white. If the label says white bread or simply bread, then you know the loaf is made with low-fiber refined flour. A label can say "whole wheat" bread only if the bread is made from 100 percent whole-wheat flour. No refined flour is allowed. Without that word "whole," you're on your own. And there are no standard regulations for the specialty breads and crackers that fall between white and whole wheat bread. You can't assume that wheat means whole wheat. "Wheat" may simple mean white flour. Likewise, if the first ingredient on the loaf of bread is enriched flour, wheat flour, or anything other than "whole-wheat flour" or "stone-ground whole-wheat flour," chances are such a product has no more fiber than ordinary white bread--which is negligible.

In the dairy case, you have the choice to go all the way from whole-milk dairy products down to completely fat-free foods. Lest you startle your tastebuds and get discouraged, wean yourself from high-fat milk gradually. If you use whole milk now, go to 2 percent milk for a few weeks, and then switch to 1 percent milk. That's what we did in our household and it was painless. For those who have a high cholesterol, you might gradually go one step further to skim milk. For other dairy products, a gradual substitution isn't necessary. There are numerous low-fat and no-fat dairy products to choose from. Weight Watchers makes an excellent 1 percent fat cottage cheese.You can also purchase low-fat sour cream. For even less fat, mix it with equal portions of non-fat plain yogurt and chopped chives and serve over a steamy baked potato. Cheese contributes much of the saturated fat and cholesterol in the American diet. Made with skim milk, many low-fat cheeses are now becoming available. One breakthrough is Formagg cheese This is made with casein protein from milk but soybean oil replaces the saturated fat and cholesterol. Formag is free of lactose, higher in calcium than high-fat cheese, and delivers more nutrition. It is available in cheddar, mozzarella, provolone, ricotta, American, Swiss, and others.

There are practically no limitations when shopping for fruit and vegetables. No fruits or vegetables contain any cholesterol at all. Depending on your caloric needs, you can eat as many servings as you like. Go for variety in your produce department.. Whenever possible, fresh is best. Next best is frozen fruits and vegetables, and as a last choice, canned. Avoid fruits canned in heavy syrup.

Mom Was Right...

So, mom was right when she told you to "Eat your vegetables. They're good for you." Fruits and vegetables contain fiber which aids digestion and elimination, and lowers your blood cholesterol. Eating plenty of fruits and vegetables each day will help reduce your risk of developing the most common cancers. Dark green leafy vegetables, citrus fruits, and yellow-oranges vegetables rich in vitamins A and C are especially effective. High fiber fruits and vegetables also propel waste quickly through the intestines, reducing the time the bowel is exposed to possible cancer causing chemicals.

High-fiber foods absorb toxins and help prevent pollutants from being absorbed into your body. A well-balanced high-fiber low-fat diet provides you with the necessary ingredients for an active healthy lifestyle. Today's health insurance can be as affordable as a week's supply of fruits and vegetables. Strive for a diet that's composed of two-thirds fruit, vegetables, cereals, and whole grains. Only one-third of your calories should come from meat and dairy products. Remember to include some fiber in every meal and try to keep your total daily calorie intake from fat to less than 30 percent of your diet. It's hard to calculate, but watch for fat content on package labels. Avoid saturated fats. Try to stick to lean meats, low-fat dairy products and less oils and butter. When you shop, read the labels. Become educated about the fiber, saturated fat, and cholesterol contents of the foods that you eat. In time, healthier food choices will come automatically to you. Healthy eating gets easier every day. New products are changing the food scene and helping America eat right.

Improving your eating habits is never easy, especially at first. We know it's not easy to change a lifetime pattern of eating. Because our favorite dishes link us to our families, good times, and roots, they're awfully hard to give up even if we know they're bad for us. For most of us, it takes a good six months to weaken the bonds of old habits and to establish new ones. Begin slowly, making changes one at a time. For instance, begin by eating more fruits and cutting back on cakes. As you become more comfortable with one change, make another. Within several months, you'll probably be surprised at how well you are eating. To be most successful, get your spouse involved. Couples who work together at promoting good health are more successful than those trying to go it alone. If you have children, set a good example by being a health-conscious role model. Aquaint them early with the variety of fresh fruits and vegetables by offering them with every meal - even in small servings. Don't overcook and make food fun. Keep the atmosphere positive and enthusiastic. What about those foods you just can't give up? Go ahead and indulge occasionally. You should be concerned with the average nutritional content of your diet, not every single meal.

And, finally, don't plan on returning to your old eating ways once you have achieved a high-fiber low-fat diet. It is important to maintain the positive lifestyle changes you have made. Once you discover that a healthy way of eating can also be delicious and satisfying, you should have no trouble making healthy eating a permanent part of your life.

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