The government's new diet guidelines may be hard to swallow.
By Daniel DeNoon
Reviewed By Michael Smith, MD
We can all be healthy, promise the new U.S. diet guidelines. Or can we?
Your father's dinner plate featured a meat or fish entree. Vegetables were side items: something starchy, and something green -- both, like the white dinner rolls, slathered with butter. Maybe there was a salad for starters. Almost certainly there was a dessert.
If this is what your dinner plate looks like, the U.S. health and agriculture departments now say, forget about it. The plate should be alive with colorful vegetables such as purple eggplant, dark green kale, and bright orange winter squash - all without butter. If there's any meat at all on the plate, it will be no more than three lean ounces of beef, chicken, or much-preferred fish.
That's not all. You'll need five servings of vegetables, four servings of fruit, three cups of low-fat dairy foods, and 6 ounces of whole grains every single day. Cut back on salt. Eat only healthy oils and no bad fats. Stay away from sweets and sugar-added beverages. Drink very little or no alcohol. Exercise for at least 30 minutes every day. Or better still, exercise for 60 to 90 minutes daily.
We all need to eat better. But this is just not a reasonable target, says nutritionist Annette Dickinson, PhD, president of the Council for Responsible Nutrition, a trade association of dietary supplement manufacturers.
"I think there is a risk of these guidelines setting people up for failure," Dickinson tells WebMD. "We know that people already aren't doing what the last guidelines said. Yet these are more stringent. It is good to have a goal to shoot for. But this is just not a real-life solution."
Don't Let It Scare You
Arguably, few have done more to change the American diet than Mark Bittman, author of the weekly New York Times cooking column "The Minimalist." Bittman's best-selling 1998 How to Cook Everything toned down the buttery rich recipes of James Beard and Julia Childs. His claim to fame - soon to be demonstrated in a new PBS series in which famous U.S. chefs will challenge him to make simpler versions of their signature dishes - is that modern times call for lower-fat, simpler recipes.
Yet Bittman is wary of the new guidelines. He says there's little doubt they are a recipe for health. It's just not a very appealing recipe.
"I couldn't follow those guidelines," Bittman tells WebMD. "I look at these guidelines and I am going to adapt to as many of them as I can. But am I going to let this stuff scare me and run my life? Not unless I have to."
Bittman says that it would take a heart attack to motivate some people to change their diet. That's altogether too true, says Roger S. Blumenthal, MD, director of the Johns Hopkins Ciccarone Preventive Cardiology Center and co-author of the Betty Crocker Healthy Heart Cookbook.
"Heart disease and stroke don't just appear on the day a person has a disabling attack. People have to realize that you may not get a warning. Your first symptom may not be a mild heart attack --it may be a disabling stroke, the thing everybody fears," Blumenthal tells WebMD. "The cornerstone of prevention is better diet and exercise. One's eating habits when one is younger play a role, so what we eat influences our children's health for the rest of their lives. We need to be more aware of this. And that it's never too late to start a heart-healthy diet."
The Guidelines Go Shopping
Dickinson points out that the guidelines are based on long-term studies that compared people who ate the most vegetables and fruits to those who ate the least. But, she says, the guidelines go far beyond what even the most voracious vegetable eaters ate in these studies.
"I do think this is more extreme -- more extreme than we really have evidence for," Dickinson says. "If we say that people who eat more vegetables and grains and fruits are more healthy, that is true. But even those people aren't eating these quantities.
Dickinson has come up with a weekly shopping list based on the guidelines. It feeds just one person, so multiply it by the number of average-size people in your family:
- 14 cups per week of fruit without added sugars or fats: oranges, orange juice, apples, apple juice, bananas, grapes, melons, berries, raisins
- 3 cups per week of dark green vegetables: broccoli, spinach, romaine, collard greens, turnip greens, mustard greens
- 2 cups per week of orange vegetables: carrots, sweet potatoes, winter squash, pumpkin
- 3 cups per week of legumes: pinto beans, kidney beans, lentils, chickpeas, tofu
- 3 cups per week of starchy vegetables: white potatoes, corn, green peas
- 6.5 cups per week of other vegetables: tomatoes, tomato juice, lettuce, green beans, onions
- 21 servings (ounces) per week of whole grains: whole wheat and rye breads, whole-grain cereals and crackers, oatmeal, brown rice
- 21 servings (ounces) per week of other grains: white breads, enriched-grain cereals and crackers, enriched pasta, white rice
- 38.5 ounces per week of lean meat or beans: meat, poultry, fish, dry beans and peas, eggs, nuts, seeds. Count beans and peas either in this group or with legumes in the vegetables group.
- 21 cups per week of milk: Food pattern is based on skim milk. Fat or added sugar in other dairy products will count against discretionary calories.
- 154 grams (5.5 ounces) per week of oils: vegetable oils and soft vegetable oil spreads that are free of trans fats.
- 1,456 discretionary calories per week (208 calories per day). "Do all this, and here is your treat: 208 calories a day of 'discretionary calories,'" Dickinson says. "That is not just candy and stuff. It is any of the fats or sugars that are added to any of these foods. And it includes any alcohol you may consume."
It's not an easy shopping list. And it's not cheap - either in dollars or in calories, Dickinson points out.
Vitamin and Mineral Supplements?
As head of a group that lobbies for supplement makers -- and as a nutritionist -- Dickinson is disappointed that the guidelines don't endorse vitamin/mineral supplements, even though they do endorse supplement-fortified foods.
"From surveys that have been done over decades, we know that hardly anybody gets all the nutrients they need from diet alone," she says. "It is eminently reasonable to recommend that most people get a multivitamin a day. There is only so much juggling of the diet you can do."
And as people struggle to meet their 2,000 calorie limit, they may be tempted to cut out nutritious foods -- particularly calcium-rich dairy foods. This may also happen when people reach another limit -- the end of their food budgets. In both cases, inexpensive supplements may fill the gap.
"I am a big proponent of taking a daily vitamin - we call it the insurance pill around our house," Zelman says.
Leslie Bonci, MPH, RD, director of sports nutrition at the University of Pittsburgh Medical Center and nutritional consultant to the Pittsburgh Steelers, also agrees with Dickinson -- up to a point.
"If people really step up to their plates and are able to make changes and increase their whole fruits and vegetables and dairy foods, they won't need supplements," Bonci tells WebMD. "But because everybody isn't going to be making this transition overnight, a multiple-vitamin-and-mineral supplement is fine."
That said, Bonci and Zelman both stress that the body needs healthy food.
"All those things in the guidelines, those dark greens and deep oranges and so on -- all those phytonutrients in the food -- are not going to be in the supplement," Bonci says. "You can take a Centrum, but you still have to eat your spinach."
Getting the Most From the Guidelines
Here's the problem: We Americans know we aren't eating healthy enough. If the guidelines scare us, it's only because we've become used to more unhealthy habits than most of us care to admit. Sure, the guidelines are a blueprint for building a healthy body. But Rome wasn't built in a day.
"People truly have to think about where they are right now," Bonci says. "People need to honestly ask themselves, 'Am I even willing even to eat more fruits and vegetables?' For some people, the idea of red, yellow, orange, purple, and green foods - well, if it's not a gummy bear, they are going to say no. They just won't do it."
One way to get a handle on this is to think about how much food you're going to eat over the course of the day. Think about what kinds of foods you'll emphasize, and which ones you'll have less of.
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"So say, 'OK, I am willing to change the look of my plate. I'm going toward half of that being fruits or vegetables and one quarter of it protein and one quarter starch,'" Bonci advises. "That is easier for people, to draw a line on the plate and go from there. In and of itself that is going to cut down calories, because the bulk of the plate is going to be foods with a lower energy density to it, without having to go into the rigors and logistics of counting calories."
Does this still sound too hard? Hang in there. Don't throw your hands in the air. Do not run to the nearest hamburger joint or fried chicken outlet.
"Start where you are today and look toward guidelines as goals," Zelman says. "If you are eating one serving of vegetables, eat two or three. Don't let the number intimidate you. If you are not exercising, 90 minutes a day is too much. Take baby steps. Make the changes in your lifestyle that help you incorporate some of these recommendations a little at a time. Don't let it make you crazy."
Eating, Bittman says, is one of the truly consistent pleasures. We can't deny that. So we have to find ways to get our pleasure while keeping our health.
"Eating just two pieces of shrimp or a steak the size of a small McDonald's hamburger -- I think most people are going to find that an exercise in frustration," Bittman says. "Those of us who eat meat really like to tuck in. You like to take a few good bites. So the thing is to do trades and figure you are going to eat a chunk of meat once a week instead of twice a day as a lot of people do."
The Bittman plan: Set a rough limit for yourself. Be aware of the calories in different kinds of food, but don't get obsessed with counting them. Get half your calories from plant foods -- not counting the oils used to flavor them.
Is a Hamburger and Fries So Bad?
"If you get half of your food intake from vegetables and fruits and whole grains, the other half wouldn't be that bad for you unless you were eating suet," Bittman says. "Even if you get 600 calories from a Big Mac and 450 calories from a medium order of fries, if the rest of your day's diet were broccoli and apples and bulgur, you wouldn't be that bad off."
Look on the positive side, Bittman says. It is satisfying to eat beautiful vegetables. It is satisfying to eat rich whole grains.
"Use a strategy of seeing the big picture. Say, 'I am going to try to eat two cups each of vegetables and fruit every day, and a cup or two of whole grains every day,'" he advises. "I know that is going to leave me hungry. But at least I have eaten the stuff that has the fiber, that has the lack of fat, that has the omega-3 fatty acids. And then I am going to go ahead and put my olive oil on it and eat my meat and fish. I can eat smaller quantities. I just don't have the willpower to go in any other direction."
Bittman remembers the old days, when he and three friends would devour a four-pound pot roast. Last weekend, he cooked a 2 1/2 pound chuck roast for a five-person Super Bowl party -- and there were leftovers.
"That never used to happen -- everybody took just a small piece of meat," he says. "We wound up eating five or six ounces. That is probably more than it should be, but I felt very restrained. It was a pack-of-cards-sized piece of meat. Now if I have to feel guilty about that -- well, I don't know that I can go there."
Published Feb. 8, 2005.
SOURCES: U.S. Department of Health and Human Services and U.S. Department of Agriculture, Dietary Guidelines for Americans 2005, January 2005. Mark Bittman, author, How to Cook Everything; columnist, "The Minimalist," The New York Times. Leslie Bonci, MPH, RD, director of sports nutrition, University of Pittsburgh Medical Center; nutrition consultant, Pittsburgh Steelers and Pittsburgh Ballet Theatre. Roger S. Blumenthal, MD, director, Johns Hopkins Ciccarone Preventive Cardiology Center, Baltimore. Annette Dickinson, PhD, president, Council for Responsible Nutrition. Kathleen Zelman, MPH, RD, LD, director of nutrition, WebMD Health.
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