Healthy diet
Hippocrates, the father of medicine, once said:
“Consider food thy medicine and medicine thy food.”
Food is as important for our health as medicine.
A large number of diseases are associated with food.
In some areas of the world the lack of food is the cause of malnutrition and its consequences, but in other areas the problem is just the opposite, the excess of food.
In 1994 in the USA less than 14% had obesity (BMI >30). This number increased to 26% in 2014. In the same period, diabetes increased from <4.5% to more than 9% of the population (http://www.cdc.gov/diabetes/data). The consequence was that in the USA cardiovascular disease increased to 41.5 % in 2015 (National Center for Statistics).
Unfortunately this trend is worldwide. Diabetes type 2 increased from 108 million people or 4.7% of the world population in 1980 to 422 million people or 8.5% in 2014 ( 1 ).
The change in eating habits and physical activity are causing an epidemic of obesity, diabetes, hypertension, cardiovascular disease, cancer, and premature death.
How can we keep a good health?
Two factors play a major role: food and physical activity.
Intake of calories and energy expended.
Most of the energy we need daily comes from carbohydrates, proteins and fats, what are called macronutrients.
Let’s consider each group
Carbohydrates should make up 45 to 65 percent of total caloric intake.
But both the quantity and type of carbohydrate are important.
Some carbohydrates are very quickly digested and release energy fast. But because insulin level increase, the sugar level also decrease fast and we feel hungry sooner and consequently we eat more. This is called carbohydrate with high glycemic index.
Some examples are maltose (beer), glucose, baked potatoes, French fries, rice flour, mashed potatoes, potato chips, honey, corn flakes, popcorn, sugar, white bread, chocolate bars, cola, soda, cookies, white rice, noodles .
Several prospective studies have associated diets high in glycemic index with risk of developing type 2 diabetes mellitus, coronary heart disease, and some cancers.
The average American diet have 10% of their daily calories as sugar. But about 10% of Americans have 25% of their daily calories as sugar. This group that eat more sugar have the chance to die of a heart disease doubled (2).
The other type of carbohydrate is slowly digested, release energy slowly, and consequently we feel full longer and we eat less. This is the low glycemic index carbohydrates.
Examples are: whole wheat bread, brown rice, sweat potatoes, spaghetti (al dente), oatmeal, 100% integral bread, quinoa, dairy products, fresh fruits, dark chocolate (>70% cacao), soy, peanuts, green vegetables, tomatoes.
Low glycemic index carbohydrates are associated with better weight, glycemic and lipids control and lower risk of heart disease.
So the first lesson is to avoid sugar and other carbohydrates of high glycemic index and substitute with low glycemic index carbohydrates.
What about proteins?
Protein should make up 10 to 35 percent of total caloric intake.
Common sources of dietary protein include meat, fish, egg, vegetables, milk, beans, nuts, whey, soybean.
Again the quantity and source of protein has a differential impact on health
Diet with high animal protein (>20%) is associated with 74% increase in mortality, 433% increase in cancer death and 393% increase in diabetes. In special, red meats are associated with increased mortality, compared with white meats.
This association is abolished with vegetable protein (3).
- Fish –A 2014 meta-analysis of 11 prospective cohort studies found that fish consumption ≥four times a week was associated with a decreased risk of acute coronary syndrome [4]. Long-term consumption of fish oil and n-3 fatty acids reduces the risk of cardiovascular disease.
Fat should make up 20 to 35 percent of total caloric intake.
The fat found in dairy and red meat is called saturated fat. Saturated fat increase LDL (bad cholesterol) and HDL (good cholesterol).
Another type of fat is the trans fats (also found in low levels in dairy and meat, but in high levels in industrial products of hydrogenation of polyunsaturated fat, such as in margarines, cookies, cake, deep fried food). The trans fat increase LDL and reduce HDL cholesterol, so have a more deleterious effect than the saturated fats, increasing even more the risk of coronary heart disease.
In the other hand, fats from vegetables such safflower, sunflower and corn, called polyunsaturated fat and olive and canola oil (monounsaturated fat) are beneficial for our health.
Fiber is the portion of plants that cannot be digested by enzymes in the gastrointestinal tract. Fiber is available in fruits and vegetables. Increased fiber intake is associated with decreased risk in cardiovascular events [5-10], cancer [11], and all-cause mortality [12]. Patients should be advised to replace refined grains (eg, white rice, white bread) with whole grains (eg, brown rice, whole-wheat bread), which have higher fiber content.
Fruits consumption reduce blood pressure, glucose level, the risk of ischemic and hemorrhagic stroke, major coronary artery events and cardiovascular death (13)
- Nuts – A study found that the risk of myocardial infarction or stroke was reduced among participants who consumed nuts five or more times per week compared with participants who rarely ate nuts [14].
Second lesson is eat more vegetables, fruits and nuts daily and one to two servings of oily fish weekly.
MICRONUTRIENTS — Nutrients needed in very small amounts are called micronutrients and include several minerals (eg, sodium, calcium) and vitamins
Sodium — The recommended dietary sodium intake for the general population is less than 2300 mg per day. Avoid too much salt.
Calcium and vitamin D — Recommended calcium intake is 1200 mg for postmenopausal women and 1000 mg for other individuals; recommended vitamin D intake is 600 international units (IU) daily (or 800 IU daily if aged 70 years or older) [15].
Sweetened beverages — These beverages are a key contributor to weight gain and obesity [16], increased risk of coronary heart disease (CHD), type 2 diabetes, hypertension, and metabolic syndrome [17-23].
The consumption of soft drinks and other sweetened beverages should be discouraged. Drink plain water rather than sweetened beverages.
An example of a good diet is the mediterranean diet — typically high in fruits, vegetables, whole grains, beans, nuts, and seeds; include olive oil as an important source of monounsaturated fat. There are typically low to moderate amounts of fish, poultry, and dairy products, with little red meat.
The Mediterranean diet is associated with several health benefits; reductions in overall mortality, cardiovascular mortality, cancer, Parkinson and Alzheimer disease (24,29,30]. Studies have also found that a Mediterranean diet was associated with decreased risk for colorectal, prostate, digestive, pharyngeal, and breast cancer [16, 28, 31-33, 37].
A systematic review showed good evidence that mediterranean diet improved HbA1c and glucose level, decreased insulin resistance and mortality (35)
In conclusion, what would you say if a doctor offered a medicine that reduce the chance of colon cancer in 70%, stroke in 70%, in CAD 80% and Diabetes type 2 in 90%?
Well this medicine is available to all of us for free:
- diet with less saturated and trans fats, and low glycemic index,
- physical activity (walking 30 min a day),
- not smoking
- weight control ( BMI < 25 kg/m2).
If you follow these 4 healthy habits, you will have higher chance to avoid diabetes type 2, coronary heart disease, stroke and colon cancer.(36)
(1 ) http://www.who.int/mediacentre/factsheet/fs312/en/ updated Nov 2017
(2). Jama Intern med 2014;174 (4) 516-524.
(3). Levine ME Cell Metabolism 2014; 19:407-17
(13) N Engl J Med 2016; 374:1332-1343
(35) Sleiman, Front. Public Health, 28 April 2015 / https://doi.org/103389/fpubh.2015.00069
(36) Willett WC: Science 296:695-698, 2002. Spring B et al., Circulation, 2013 Nov 5; 128(19):2169-76.
(37) Graham A Colditz, David Seres, Jean E Mulder, Healthy diet in adults. This topic last updated: Jul 16, 2018.
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