What is healthy eating?

What is healthy eating? Seems like a simple question. But there is so much information (and misinformation) out there, that it can be hard to tease out the answer. I have a bachelor’s degree in dietetics, a doctorate in medicine, training in integrative medicine: and it is still hard for me to interpret all the information out there. But I have taken my knowledge and training to come to conclusions on this topic: not only to know what to feed my own family, but for the families I help in my pediatric practice. The short answer: eat when hungry, eat the right variety and types of real food and stop when full.

healthy-eating

Seems simple, right? But in today’s society that can be hard to do. In this article I’m going to review the problem with the standard American diet (ironically the acronym is SAD), the barriers to eating healthy, and an overview of what is the solution.  

 The Problem 

Americans are unwell: 1/3 of kids are overweight or obese (so only 2/3 are healthy weight), 2/3 of adults are overweight or obese (so only 1/3 are healthy weight). CDC statistics Chronic disease is increasing: type 2 diabetes, heart disease, cancer, asthma. (chronic disease in children). Pediatricians used to manage acute illnesses and not chronic illnesses.  But unfortunately now 10% of American children have a chronic condition, and pediatricians are having to manage things that used to be “adult” conditions, such as type 2 diabetes and high blood pressure.

The average American today eats too many “empty calories”, meaning the SAD has high calorie foods that has low nutrients. Today’s children are overweight and malnourished. And again, today’s children are already getting unhealthy diseases such as type 2 diabetes and heart disease. Because of this they may have a shorter lifespan than their parents. For the first time in human society, we are regressing instead of making progress with health.

Evolution-of-Obesity

This increase in overweight and chronic disease started in 1970, before that childhood obesity had been at 5% for decades, which was mostly due to genetic disorders (such as Prader-Willi, etc).  ChildObes71toPres

So what were we doing better before 1970? Simply put: We grew, prepared, and cooked our own food. Americans are getting further away from the food we eat. We’ve been told that we don’t have the time or money to make food, so we should let the companies do it for us. 

swanson

The problem is when we rely on someone else to make our food, they don’t care if they make it healthy, they are a business and goal is to make it as cheaply as possible to increase their profit.  Again, we are eating more food, but less nutrients (again which increases profit for the companies). 

 The Barriers

Time and money: Again, our society has shifted it’s values, mostly due to increase in consumerism. We are surrounded by messages that food doesn’t have to be a priority so the companies can do it and make money. We need to shift our value back to valuing food as a priority. I hear all the time that families feel they don’t have the time or money for healthy food. But the average American watches 4.5 hours of tv per day, how about using part of that to cook a healthy meal? And the amount of money we spend on food has declined in the past 100 years, how about at least going back to spending 15% of household income on good healthy food?  

thr-income-spent-on-food_custom-ed63b133b0b3914191e299c179a61271caa0db71-s1400-c85

 Environment: The food companies have infiltrated our society. It’s easier in America to eat junk food. It’s harder to find, prepare and eat healthy food.  

130627100234-vending-machine-school-student-horizontal-large-gallery

 Misleading information: One reason for this is research is hard to do for eating due too many variables involved.  Also consumerism uses that information and twists it to their advantage (I will discuss this below about fat and sugar). A comical example of this is fiber one bars. So a study shows fiber decreases cholesterol, so a company makes fiber one bars to make people think it is “healthy” and sell the bars. But was it really the fiber itself, or that fiber is found in plant based highly nutritious foods? Again I find myself laughing at the commercials: the poor guy is eating a salad missing all the fun with his friends, but with a fiber one bar he’s much more cool! The message they try to convey is “There’s a better way to eat your fiber”: so instead of nutritious salad, it’s “cooler” in society to eat a chocolate bar with some wood pulp “fiber” in it?!

fiber-one-oats-and-chocolate-bowling-alley-song-by-berlin-large-2fiberone

 The solution 

To solve a problem, we have to get to root of problem. So what changed from 1970? The All American meal changed from homemade meals of vegetables and protein; to fast food meals of hamburger, fries and soda.  

There is evidence to show this for America: the amount of carbohydrates increased, mostly in the form of corn syrup in processed foods.

cdc carb

You may also notice that fat consumption went down in that graph. Another thing that happened around 1970 was fat started to get a bad reputation.  A study showed a diet low in saturated fat decreased heart disease. But America misinterpreted the information, and misinformation spread. The real information was that Mediterranean countries that had a diet low saturated fat, but high in unsaturated fat (think Italy with fish and olive oil), had less heart disease. But instead American consumerism latched onto “low fat” craze: Americans were brainwashed to think that fat made us fat, and to replace it with sugar. (fat versus sugar) We are now learning sugar is worse for us than the saturated fat we originally thought was “bad”. Plus the low fat “diet” did not make us feel full (fat increases fullness, and sugar actually makes you hungrier), so people had to count calories to self restrict because they never felt full (this is when Weight Watchers became successful).

wwLow fat, so it must not make you fat, right?!

So all of this sounds confusing: so the egg yolks and nuts that we were told would make us unhealthy was actually making us full and more nourished, so now we can eat them again?! See how misinformation and consumerism can mix the messages. I will try to re-teach “what is healthy” more in depth in future articles. A useful website is healthline, it uses evidence to come to conclusions and has lots of great information, it explains some of the myths around fat: healthline.com . There are also a couple of interesting books: 

Salt sugar fat: how the food giants hooked us. By Michael Moss

Food rules: An eater’s manual. By Michael Pollan

Ok, so the problem is relying on companies to make our food, and fat isn’t necessarily the enemy but sugar is the enemy.  So how do we get back to the 1970 diet? Below is some big picture target behaviors that I made in a handout for children:

healthyruleshandout

  1. Limit portion size

Food companies have gotten really good at making a lot of food cheaply. Plus the more food they sell the more money they make. The average portion has tripled since 1970. A normal portion size is the size of a person’s palm, keep this in mind. In our home, if you’ve eating a palm size portion and you’re still hungry, eat a different food to increase variety.

portion

  1. Limit consumption of high calorie, low nutrient foods

The further away from nature, the more good stuff has been taken out, and the more bad stuff is added. Plus companies make processed food taste supernatural so you eat more. Kids are literally addicted to processed foods. It starts young: “baby cheetos” and “baby sugar melts” changes taste buds to like more salty and sugar food, so natural food like vegetables taste like dirt in comparison.  

The solution is to eat food that is “closer to nature” as possible. Take a look in your fridge and pantry, and make a list of what you usually eat, and see if there are better choices. For instance, if you eat a nutrigrain bar for breakfast or snack, the closer to nature form would be oatmeal with real fruit.   

  1. Meal choices

Nutrients are building blocks we need for our body to grow and function, and we need certain types in certain amounts. 

Macronutrients are carbohydrate, fat, and protein. Micronutrients are vitamins and minerals. I will give you more information in a future article on nutrition 101 about how to balance food variety to get the right mix of nutrients. But for now, here is a handout I developed of a healthy plate which is a good visual of what a healthy type and variety: 

healthyplate

Also eat homemade meals as family. Again, if you make your own food you make it healthy. And when kids eat with parents they eat better. Parents are in charge of the what kids eat, kids are in charge of how much they eat: KIDS ARE NOT IN CHARGE OF THE WHAT THEY EAT. Kids do not have insight to know what is healthy, they only know what tastes good and is familiar, so they will trick adults into feeding them granola bars and mac/cheese (aka “mom I’m going to starve if I don’t get Mac/cheese” or they don’t eat their meal but then they ask for granola bar). Dr. Ellyn Satter has done lots of research on how to prevent “picky eaters”, and she terms it division of responsibility of eating (Division of responsibility feeding children) Kids will not let themselves starve even if the only food available was broccoli. The problem is in American there is a plethora of types and amount of foods. In our home: I make healthy meals and and have healthy snack options, and that’s what’s to eat (if they don’t eat at least half of meal, it goes in fridge and that’s what they eat later, to avoid them just snacking all day), and we only have water and white milk to drink (anything else is a treat, like at a birthday party). And the tough love worked: now my family eats any vegetable and prefers water to sugary beverages, and they didn’t starve😉  

  1. Physical activity

Another thing that is changed is Americans aren’t as active. Children should have at least 60 minutes of activity per day. Their screen time should be limited to maximum of 2 hours: for many reasons, but also to get them off the couch and get moving! 

  1. Increase fruits and vegetables

Vegetables and fruit are literally the healthiest thing you can eat: they have the most nutrients per calorie. Unfortunately they are the least eaten in America.  Studies estimate the average American child eats 2 servings of vegetables and fruit per day, and that includes potatoes and iceberg lettuce (aka french fries and lettuce on hamburger). (AAP prevention of obesity) 

It is recommended children eat at least 5 servings of vegetables and fruits per day to get the recommended nutrients. Plus, those are replacing less nutritious forms of food. In our home our rule is: every meal and snack needs a vegetable or fruit. Therefore 3 meals and 2 snacks a day = 5 servings vegetables and fruit.  

*A note on juice: juice is the squeezed out sugar and water from fruit and vegetables. And it’s sugar without the good stuff in the whole piece of fruit with fiber. Plus, it’s concentrated source of sugar. For instance, it takes about 4 oranges to make 8 oz of orange juice, that’s about 30 grams of sugar! Therefore, I consider juice a sugary beverage and is a “treat” a maximum once a week.

  1. Limit sugar 

At high levels sugar is a poison to the body: causes endocrine problems such as diabetes, causes inflammation, increases risk of cancer and heart disease. In fact, sugar directly increases the risk for cardiac death: the only controllable thing that has been proven besides tobacco use to increase death from heart disease (Sugar and heart disease). There is also no nutrients in sugar, so it’s just empty extra calories that get stored as fat. Also, when you eat sugar, it makes you hungrier because of the sugar high that then leads to sugar low that stimulates hunger .

Added sugar is sugar not naturally found in natural food (aka the sugar mixed into processed foods like flavored yogurt). Sugar in fruit and vegetables has the nutrients, plus nature is smart and doesn’t put too much sugar in a serving (1 serving of fruit is typically 5-10 grams of sugar).  The maximum daily amount of added sugar is 25 grams for children. Unfortunately the average American child eats 90 grams of added sugar per day.  Most people don’t realize 4 grams of sugar = 1 teaspoon of sugar (food companies use this as another way to trick the consumer, if you knew the yogurt had 6 teaspoons of sugar dissolved in it, you probably would think twice about eating it, but 24 grams sounds like 24 little granules and doesn’t sound as bad). So if it’s a poison in high amounts, then why is so much sugar added to processed foods? Well companies know if they add sugar, it will taste good, and people will be more likely to buy it.  And that’s the companies goal: to sell more and make more money (AAP Sugar)

SugarStatement-Infographic-08.16.161-1024x712yoplait

 Take home message

Well those are the key points of what this pediatrician and mom has come to the conclusion of what is healthy eating. You don’t have to memorize a bunch of rules, or count calories, or start the latest fad “diet” (I dislike the way the term diet has turned into a fad, the best diet is a healthy lifestyle of the right balance and type of real food!).

Just choose the right type and variety of real food: the most of what you should eat is plant based (vegetables, fruit, nuts, whole grains, beans, olive oil, coconut oil), in the middle is whole animal products (eggs, dairy, meat), and lowest amount of what you should eat is processed foods and added sugar. 

Simple, right?! Everyone can improve their lifestyle. What you’re doing now is a habit, meaning that  you do it so often that your brain makes a short pathway so you don’t have to think hard about doing it. When you are changing habits, at first you have to work and think harder, but eventually it becomes a new habit. So just take a look at what you do now, and see if you can improve, and work on 1 thing at a time.  Once the healthier choice is a habit that you don’t have to think or work hard to do, then work on the next habit, etc. So set 1 goal right now: ready, set, go! And I will keep writing and giving knowledge and tips to help!

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