The G.R.A.D.E diet is a wonderful start to healthier eating. All too often, patients ask me for specifics on what types of foods are healthy and unhealthy. It can be a bit overwhelming. Here’s a synopsis that gives a more detailed overview of food choices and how they impact our diet.
According to the American Journal of Medicine, diet is the most significant risk factor for disability and premature death. While there are many resources available to the public, not many of us adhere to readily available guidelines. Did you know the government publishes a whole guide around dietary recommendations? It is available here to read, and includes everything you’d ever need to know on healthy eating and food related information.
Before going into which diets offer well-rounded guidelines, let’s sort through what the Glycemic Index is, and how foods affect your insulin and glucose levels. Maintaining steady glucose and insulin levels is the secret to losing weight, reducing the risk of Type-2 Diabetes and heart disease, and maintaining long term good health.
Glycemic Index:
The glycemic index (or GI) is a ranking of carbohydrates on a scale from 0 to 100 according to the extent to which they raise blood sugar (glucose) levels after eating. Foods with a high GI, such as white bread (75), white rice (73), potatoes (78), and rice crackers (87) are those which are rapidly digested, absorbed and metabolised and result in marked fluctuations in blood sugar (glucose) levels.
Low GI carbohydrates such as corn tortillas (46), barley (28), rice noodles (53), apples (36), chick peas (28), and kidney beans (24), are the foods that produce smaller fluctuations in your blood glucose and insulin levels.
There are many diets being touted, but most have not been studied. Their true value, or risk, is unsubstantiated. Multiple medical journals, including the June 1, 2018 American Family Physician Journal, have shown evidence that the Mediterranean diet helps prevent and decreases the occurrence of many conditions. It has been shown to prevent Type-2 Diabetes, decrease cancer incidence and mortality, prevents age related cognitive decline, and prevents cardiovascular disease (both incidence and mortality). Besides that, it also decreases overall mortality, and treats obesity by emphasizing plant foods such as fruits, vegetables, legumes, whole grain, seeds, tree nuts, as well as moderate fish consumption.
The Mediterranean Diet includes low amounts of dairy products, red meats, and processed items. Olive Oil is the principal fat. The Journal of the American Medical Association (JAMA) states there’s mounting evidence that this diet may also be valuable in preventing and treating frailty in older patients. Frailty being defined as someone experiencing 3 of the 5 following criteria:
-unintentional weight loss of 10 pounds in the last year
-exhaustion
-weakness as measured by grip
-slow walking speed
-low physical activity
This conclusion is likely due to specific components of the diet that have anti- inflammatory effects like salmon, avocados, and newly-pressed extra virgin olive oil (which contains a phenolic compound with anti- inflammatory effects similar to ibuprofen). It’s a diet that encourages healthy eating, communal and social cooking, adequate rest and 30 minutes of physical activity daily.
The National Institute of Health to Treat Hypertension has come up with (DASH): Dietary Approaches to Stop Hypertension. There’s strong evidence it improves risk factors for cardiovascular disease and lowers blood pressure. But, there is limited evidence for weight loss and managing or preventing Type-2 Diabetes.
The 2015 Dietary Guidelines for Americans, Choose My Plate (USDA), and Healthy Eating Plate (Harvard University), all offer useful guidelines for eating healthy. The Healthy Eating Plate is consistent with the Mediterranean diet and emphasizes covering 1/2 of the plate with fruits and vegetables, 1/4 with whole grains and the remaining 1/4 with healthy proteins; recommending water as the primary beverage and increasing daily physical activity. All of these diets limit added sugars, sweetened beverages, and highly refined grains.
Large prospective studies in a review in Public Health Nutrition showed that primarily vegetarian diets reduce the risk of coronary artery disease and Type-2 Diabetes. Vegan diets benefit patients with obesity, hypertension, Type-2 Diabetes, and other cardiovascular risk factors. But, adhering to a vegan or vegetarian diet long-term can be difficult, if not impossible, to do in this society. Let’s talk about options that work well and keep us healthy in any environment.
Fruits and Vegetables:
As I stated, most dietary guidelines recommend that 1/2 of every meal consist of vegetables and fruits. Whole fruits and vegetables are preferred over juices because they have a higher fiber content and lower glycemic index.
Eating more fresh fruits has been associated with decreasing coronary artery disease, cerebrovascular disease, cancer and gastrointestinal conditions. Participants in the Nurses Health Study and the Health Professionals Follow-Up Study who had the highest intake of fruit and vegetables-more than five servings per day, had a 30% decrease in the risk of cardiovascular disease compared with those who only ate one and a half servings or less per day. Potatoes are more nutritionally similar to grains so are not included in this category. Green leafy vegetables have the most benefit, and nine daily servings of vegetables and fruits in a variety of colors to maximize different phytochemicals, antioxidants, and vitamins, are recommended.
Legumes:
Legumes are plants or fruit or seed from plants. Included in this category is a variety of beans that are high in soluble fiber, protein, iron, carbohydrates, vitamins, and minerals. A few examples are: alfalfa, peas, beans, soybeans, lentils, kidney beans, lima beans, and mung beans. Because of their unique nutrients, legumes are considered both a protein and a vegetable. For example, a 100-gram serving of chick peas contains 18% of the daily recommended value for protein. They contain no cholesterol and little fat or salt. Eating legumes four times per week, compared with less than once per week, was found to reduce cardiovascular disease and coronary artery risk, reoccurrence of colorectal polyps, improve longevity and blood glucose control, and improve weight management. USDA dietary guidelines recommend eating 1 1/2- 3 cups of beans per week.
Grains:
It’s often difficult to understand which grains are considered healthy. Stay away from the more highly refined grain products such as white bread. Diets high in processed grains have a greater incidence of inflammation, cardiovascular disease, poorly controlled Type-2 Diabetes, and difficulty losing weight. Instead, turn to minimally processed whole grains such as brown rice, corn, 100% whole wheat and oat products, and potatoes. Whole grains have a higher nutritional value with more vitamins, protein, and fiber than processed grains and help to decrease rates of cardiovascular disease. The USDA dietary guidelines recommend 1- 3 cups of grains per day, with at least half of the allowance being whole grains.
Fiber:
Soluble fiber comes in the form of carrots, cucumbers, seeds, tomatoes, whole grains, and zucchini. Insoluble fiber can be found in foods such as apples, beans, blueberries, lentils and oatmeal. They are associated with improvements in irritable bowel syndrome, lower cardiovascular disease, a decrease in premature death, lower blood pressure, lower LDL cholesterol levels, and lower breast cancer risk. USDA dietary guidelines recommend consuming a minimum of 14g of fiber per 1000 calories, each day.
Oils, Fats and Nuts:
As we discussed in a previous post, dietary fat is either saturated, polyunsaturated or monounsaturated. All are necessary nutrients, and every fat-containing food has some combination of the three. Trans fats are dangerous and have been banned.
As a society, we have been trying to decrease our fat intake for the last decade. We tended to turn to eating more refined carbohydrates instead. This then caused a substantial increase in overall calories, triglyceride levels, Type-2 Diabetes, weight gain and cholesterol levels. Dietary fats affect cholesterol levels and coronary artery disease risk differently. Increasing your intake of mono or poly-unsaturated fats decreases coronary artery risk but only those based on plant saturated fats can do this.
Omega-3 fatty acids and Omega-6 fatty acids are both polyunsaturated fats. A higher level of Omega-6-fatty acids can lead to increases in thrombosis, vasospasm, cancer, and allergic and inflammatory disorders. It’s preferable to increase consumption of foods high in Omega-3 fatty acid such as fish, nuts, canola oil, and green vegetables. Limit the ratio of Omega- 3 and Omega-6 by limiting corn and vegetable oils. Monounsaturated fats in olive oil, nuts and avocados seem to help prevent cardiovascular disease.
A recent article in Family Practice News states that eating 1 1/2 ounces of walnuts leads to favorable changes in gut microbiome composition and diversity. These changes in the intestinal flora may lead to decreased levels in LDL (bad) cholesterol, triglycerides, and non HDL (good) cholesterol.
Animal Products:
Consuming red and processed meats has the most significant negative affects on health. The Archives of Internal Medicine states that there is a dose related relationship between the amount of red meat consumed and the risk of all-causes of mortality. According to the Journal of American Medical Association, higher protein and fat content relative to carbohydrates generally decreases cardiovascular risk and improves lipid levels. But, this is not the case when the protein comes from animal sources. Plant-based proteins are generally preferred such as fish, dairy, eggs, and fowl. Eggs have had a bad rap for decades, and even though they are high in cholesterol, they do not contain high amounts of saturated fats. Eating up to one egg per day does not contribute to cardiovascular disease in those without cholesterol issues. Those with type two diabetes may have a slightly increased risk of cardiovascular disease. Eggs are also rich in vitamins and protein.
Those who are lactose intolerant and unable to fully digest dairy products can easily find foods, such as fish or fowl, to replace the calcium, fats, proteins, and carbohydrates found in dairy.
Beverages:
Too often, we forget the impact drinks have on our caloric intake. Sweetened beverages such as fruit juice, soda, and energy drinks are increasingly linked to multiple chronic diseases such as hypertension, Type-2 Diabetes and obesity related cancers (Archives Of Cardiovascular Disease). The World Health Organization recommends limiting free sugars to less than 5 to 10% of daily caloric intake. Artificially sweetened drinks may also increase the risk of type two diabetes, but at 1/2 the rate as sweetened ones.
Alcohol has a lot of controversy surrounding it. Minimal to moderate intake may help brain health, insulin resistance and cardiovascular disease. However, it can also increase the risk of breast, colon, liver, throat and mouth cancers, as well as depression. It is estimated that 90% of those who drink at least 1/2 ounce a day have fatty liver changes that are benign and reversible. Continued and increased consumption can lead to permanent changes where the liver cells die and get replaced with scar tissue that leads to cirrhosis.
Water is clearly the preferable beverage and the most beneficial. Analysis of data from the National Health and Nutrition Examination Survey showed that as water intake increases, total caloric intake decreases, especially from other sugar sweetened beverages. Inadequate hydration is also associated with a higher body mass index (BMI- see our post on Body Mass Index for more info).
So drink up! Just make it water! As we’ll discuss in later blogs on exercise, water bottles are also a wonderful, inexpensive and easily accessible way to stretch and tone the upper body.
The bottom line is- while there are many resources available to assist with your dietary needs, all agree on eating healthy, keeping hydrated and exercising daily. Whatever path you choose to get there is up to you. It’s the goal that matters: a healthier lifestyle that leads to longer life and improved well-being.
-Dr. Courtney