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National Institutes of • Department of Health and • newsinhealth.nih.gov Plan Your Plate Shifting to a Healthy Eating Style

What’s the eating style that’s best , , for health? Is it a Mediterranean and more. To reach eating plan? Vegetarian? Low your goals, experts carb? With all the eating styles out advise making small, there, it’s hard to know which one gradual changes. to follow. “The best to follow Healthy eating is one of the best is one that is science ways to prevent or delay health based, that allows you problems. Eating well, along with to meet your nutritional getting enough physical activity, requirements, and can help you lower your risk of that you can stick to in health problems like heart , the long run,” says Dr. Holly Nicastro, an NIH research expert. “It’s not Limit Added going to do you any good to follow Added is the extra sugar Special Issue a diet that has you eating things that added to and drinks during you don’t like.” Healthy preparation. Corn syrup, high- The main source of science-based fructose corn syrup, brown nutrition advice is the Dietary Eating sugar, and honey are examples of Guidelines for Americans. These sweeteners added to foods and guidelines describe which drinks, especially regular sodas. you need and how much. They Plan Your Plate “The sugars present normally in 1 Shifting to a Healthy also point out which ones to limit milk and are not considered Eating Style or avoid. ,” explains Dr. Kimber “Every five years, an expert panel Sweet Stuff Stanhope, a nutrition researcher at 3 reviews all available scientific How Sugars and Sweeteners the University of California, Davis. evidence regarding nutrition and Affect Your Health Stanhope’s research focuses on health and uses that to develop the the effects of added sugar on the The Skinny on dietary guidelines,” Nicastro explains. 5 development of disease. Her studies The Good, the Bad, The guidelines are regularly and the Unknown have shown that consuming too updated, because our scientific much high-fructose corn syrup may The Salty Stuff understanding of what’s healthy increase the risk of and 7 , Blood Pressure, and is continuously evolving. These heart disease. Your Health changes can be confusing, but the The Dietary Guidelines for key recommendations have been Rough Up Your Diet Americans suggest a daily limit 9 consistent over time. In general, Fit More Fiber Into Your Day on added sugar of no more than healthy eating means getting a 10% of calories. That’s about the Better Nutrition variety of foods, limiting certain 11 amount in 16 ounces of regular Every Day kinds of carbs and , watching soda (190 calories). You can find How to Choose Healthier out for salt, and being aware of your Foods and Drinks information about added sugars portion sizes. on most Nutrition Facts labels now. 2 newsinhealth.nih.gov/special-issues

“Anybody can improve their diet in beef, chicken, pork, cheese, butter, Along with a lot of added salt, by substituting and and whole milk. Solid fats have more processed foods might have for sugar as their snacks, as part of saturated fats than liquid oils. Liquid preservatives, sweeteners, their dessert, and as part of their oils—such as canola, corn, olive, or and other substances added ,” says Stanhope. “There peanut oil—have mostly unsaturated during preparation. are no advantages of consuming or polyunsaturated fats. “Stuff that comes in a box or added sugar.” The dietary guidelines encourage a bag that has a whole lot of different consuming liquid oils rather than ingredients—many of which you In general, healthy eating solid fats. Nicastro advises that can’t read and understand or you examine the fat content on pronounce—those things are highly means getting a variety the . The processed and generally bad for your of foods, limiting certain label shows how much saturated health,” explains Dr. David C. Goff, kinds of carbs and fats, fat a product contains. Experts Jr., a expert at NIH. watching out for salt, suggest that you aim for getting less than 10% of your calories from Make a Plan and being aware of saturated fats. your portion sizes. “For the average person, that’s “Figuring out what to eat is less going to be less than 20 grams of than half the battle,” Nicastro says. per day,” Nicastro says. “Sticking to your plan is a bigger Consider Your Fats For example, a small cheeseburger challenge. So that’s why it helps to be really prepared and plan ahead.” Fat is high in calories. Getting may have 5 grams of saturated fat, You’re much more likely to stick too many calories can contribute a typical cheeseburger may have to your meal plan if you have healthy to obesity, which raises your risk 13, and a double cheeseburger with that is ready to go. Some people for heart disease and other health bacon may have 24! find it helpful to prepare meals for problems. But there are different the week in advance so that healthy kinds of fats. Check Labels for Salt food is within reach. Fats that are liquid at room The Nutrition Facts label also shows The DASH eating plan is a good temperature, or oils, are generally salt, or . Experts advise you start. DASH was developed by healthier than those that are solid. to limit salt, which tends to be very NIH-supported researchers to help Solid fats are found in high amounts high in processed foods. people lower blood pressure without If you eat salty, highly processed medicine, but it’s for anyone. Studies food, you can quickly go over the have shown that it reduces the risk NIH News in Health daily limit of one teaspoon of salt of many . ISSN 2375-6993 (Print) ISSN 1556-3898 (Online) (2,300 milligrams, or mg, of sodium). “The DASH diet is very flexible Editor Harrison Wein, Ph.D. Two hot dogs might have 900 mg of because you can follow DASH Managing Editor Tianna Hicklin, Ph.D. sodium. A can of ravioli might have without going to a specialty grocery Graphics Alan Defibaugh (illustrations), 1400 mg. Other examples of salty, store. You can follow it with items Bryan Ewsichek (design) highly processed foods are bacon, that are very familiar to most people This special issue is a collection of previously frozen pizzas, and salad dressings. in this country,” Nicastro says. published articles. However, articles were The DASH eating plan is rich in updated and re-reviewed by NIH experts fruits, vegetables, whole , prior to inclusion. Published August 2019. “Stuff that comes in beans, seeds, nuts, and fish. Use our articles and illustrations in your own a box or a bag that has publication. Our material is not copyrighted. Compared to the typical American Please acknowledge NIH News in Health as the a whole lot of different diet, it’s lower in salt, added sugars, source and send us a copy. ingredients—many of fats, and red meat. It’s also higher newsinhealth.nih.gov which you can’t read in fiber, potassium, magnesium, and than the typical and understand or American diet. pronounce—those things “Anybody can follow it, despite NIH…Turning Discovery Into Health® are highly processed specific preferences or culture,” Office of Communications & Public Liaison Nicastro says. It even works for Building 31, Room 5B52 and generally bad for people who are vegetarian or only Bethesda, MD 20892-2094 email: [email protected] your health.” eat Kosher foods. phone: 301-451-8224 newsinhealth.nih.gov/special-issues 3

You can use the weekly DASH menus and a form to track your food Sweet Stuff and physical activity habits at www. How Sugars and Sweeteners Affect Your Health nhlbi.nih.gov/health-topics/dash- eating-plan. Most of us love sweet foods and drinks. But after that Get Expert Advice short burst of sweetness, The Dietary Guidelines for you may worry about how Americans are designed to help sweets affect your waistline people avoid developing obesity, and your overall health. Is diabetes, and heart disease. But sugar truly bad for us? How everyone is different. You may have about artificial or low-calorie needs and risks that aren’t like the sweeteners? What have average American. Talk to your scientists learned about the health care provider about your sweet things that most of us unique nutritional needs. eat and drink every day? “A great resource for someone Our bodies need one type to help you with your diet is of sugar, called glucose, a registered , to survive. “Glucose is or DN,” Nicastro says. the number one food You can find this type of expert in for the brain, and it’s an your area by visiting the Academy extremely important Although sugar itself isn’t bad, of Nutrition and Dietetics at www. source of fuel throughout the Rother says, “sugar has a bad eatright.org/find-an-expert. body,” says Dr. Kristina Rother, reputation that’s mostly deserved, an NIH pediatrician and expert because we consume too much of on sweeteners. it. It’s now in just about every food Wise Choices we eat.” Make Healthy “Sugar has a bad Diet Choices reputation that’s mostly Added Sugars deserved, because we Experts agree that Americans eat ●● Eat a variety of foods—vegetables, consume too much of it. and drink way too much sugar, fruits, whole grains, beans, nuts, and it’s contributing to the obesity seeds, lean meat, seafood, eggs, It’s now in just about every milk, , and cheese. . Much of the sugar we food we eat.” eat isn’t found naturally in food ●● Limit foods that are low in but is added during processing and . But there’s no need to add extra or preparation. ●● Avoid foods with added sugar. glucose to your diet. Your body can Sugars are usually added to ●● Replace foods containing extract glucose from the sugars make foods and drinks taste better. saturated fats (like butter or and other in But such products can be high in lard) with healthier unsaturated your food. It can also produce new calories and lack the healthful fat options. glucose, mostly in the liver. That’s ●● Watch out for foods high in salt. why you can survive for a long time without eating. Some sugars are found naturally Definitions in foods, such as fruits, vegetables, and milk. “These non-processed Glucose Web Links natural foods are healthful additions A type of sugar used by the body for to your diet,” says Dr. Andrew energy. When blood glucose levels get too For more about healthy eating, go Bremer, a pediatrician and NIH high, it can damage tissues and organs to: newsinhealth.nih.gov/special- over time. issues/eating/plan-your-plate expert on sweeteners. “When you eat an orange, for instance, you’re Carbohydrates getting a lot of nutrients and dietary A class of food molecule that includes fiber along with the natural sugars.” sugars, starches, and fibers. 4 newsinhealth.nih.gov/special-issues benefits of fruits and other naturally back on added sugars. About 15% of mixed. Some studies suggest that sweet foods. the calories in the American adult diet drinks can help you drop pounds Sugar-sweetened beverages like diet now come from added sugars. in the short term. But their long- soda, energy drinks, and sports Experts recommend a daily limit term effects on weight—and other drinks are the leading source of on added sugar of no more than health aspects—are unclear. Rother added sugars in the American diet. 10% of calories. and other NIH-funded researchers Juices naturally contain a lot of But added sugars can be hard to are now working to better sugar. But sometimes, even more is identify. On a list of ingredients, understand the complex effects that added to make them taste sweeter. they may be listed as sucrose artificial sweeteners may have on “Juices offer some vitamins and (table sugar), corn sweetener, the human body. other nutrients, but in general, high-fructose corn syrup, fruit-juice Studies of rodents and small I think those benefits are greatly concentrates, nectars, raw sugar, numbers of people suggest that offset by the harmful effects of too malt syrup, maple syrup, fructose artificial sweeteners can affect much sugar,” Bremer says. sweeteners, liquid fructose, honey, the gut microbes that help us digest Over time, excess sweeteners molasses, or anhydrous dextrose. food. This in turn can alter the can take a toll on your health. Added sugar can also be listed body’s ability to use glucose, which “Several studies have found with any word ending in “-ose,” the might then lead to weight gain. But a direct link between excess chemical suffix for sugars. If any until further studies are done in sugar consumption and obesity of these words are among the first people, the long-term impact of these and cardiovascular problems few ingredients on a food label, the sweeteners on gut microbes and worldwide,” Bremer explains. food is likely high in sugar. To find weight remains uncertain. the total amount of sugar in a food, Cutting Back look for “Sugars” on the Nutrition Beyond the Gut Facts label under the category Because of these harmful effects, “Total .” “There’s much controversy about many health organizations the health effects of artificial recommend that Americans cut sweeteners and the differences To find the total amount between sugars and sweeteners,” of sugar in a food, look says Dr. Ivan de Araujo at the Mount for “Sugars” on the Sinai Icahn School of Medicine. Wise Choices “Some animal studies indicate Cut Added Sugars Nutrition Facts label that sweeteners can produce under the category physiological effects. But depending on what kind of measurement is ●● “Total Carbohydrate.” Choose , milk, or unsweet- taken, including in humans, the ened tea or coffee instead of outcomes may be conflicting.” sodas, sports drinks, energy Many people try cutting back drinks, and fruit drinks. on calories by switching from ●● Reduce sugar in recipes. If a recipe sugar-sweetened to diet foods and The key to good health says 1 cup, use 2/3 cup. drinks that contain low- or no- is eating a well-balanced ●● To enhance flavor, add vanilla, calorie sweeteners. These artificial diet with a variety of foods cinnamon, or nutmeg. sweeteners—also known as sugar substitutes—are many times and getting plenty of ●● Eat fresh, canned, frozen, and sweeter than table sugar, so smaller physical activity. dried fruits without added sugar. Choose fruits canned in their own amounts can create the same level juice or water rather than syrup. of sweetness. De Araujo and others have been People have debated the safety of ●● Use fruits to top foods like cereal studying the effects that sugars and artificial sweeteners for decades. low-calorie sweeteners might have and pancakes rather than sugars, To date, researchers have found no syrups, or other sweet toppings. on the brain. They are finding that clear evidence that any artificial sugar and sweeteners tap differently ●● Read the ingredients list to pick sweeteners approved for use in the food with little or no added sugar. into the brain’s reward circuitry, U.S. cause or other serious with sugars having a more powerful ●● Use the Nutrition Facts label to health problems like birth defects and pleasurable effect. choose packaged foods with in humans. “The part of the brain that less sugars. But can they help with weight mediates the ‘I can’t stop’ kinds of loss? The scientific evidence is newsinhealth.nih.gov/special-issues 5 behaviors seems to be especially sensitive to sugars and largely The Skinny on Fat insensitive to artificial sweeteners,” The Good, the Bad, and the Unknown de Araujo says. “Our long-term goal is really to understand if Fat is an essential for sugars or caloric sweeteners drive our bodies. It provides energy. persistent intake of food. If exposed It helps our guts absorb certain to too much sugar, does the brain vitamins from foods. But eventually change in ways that lead what types of fat should you to excess consumption? That’s what be eating? Are there any you we’d like to know.” should avoid? Some research suggests that the Recommendations about intensely sweet taste of artificial, dietary fat have shifted low-calorie sweeteners can lead to over the last two decades. a “sweet tooth,” or a preference for From the 1970s through the sweet things. This in turn might 1990s, nutrition researchers lead to overeating. But more studies emphasized eating a low-fat diet. are needed to confirm the relative This was largely because effects of caloric versus non-caloric of concerns about sweeteners. saturated fats, explains Dr. Alice H. Lichtenstein, who studies diet and Frank Sacks, a nutrition expert at Don’t Sugarcoat It heart health at Tufts University. Harvard University. “In the long run, if you want to Saturated fat that’s in the lose weight, you need to establish bloodstream raises the levels of LDL Healthy Fats a healthy lifestyle that contains —the “bad” cholesterol. Research has shown that unprocessed foods, moderate This in turn raises the risk of unsaturated fats are good for you. calories, and more ,” heart disease. These fats come mostly from plant Rother says. But when people started following sources. Cooking oils that are liquid When kids grow up eating a lot of low-fat diets, they didn’t only cut at room temperature, such as canola, sweet foods, they tend to develop a saturated fats. In many cases, they peanut, safflower, soybean, and olive preference for sweets. But if you give replaced healthy unsaturated oil, contain mostly unsaturated fat. them a variety of healthy foods like fats with processed carbohydrates, Nuts, seeds, and avocados are also fruits and vegetables early in life, explains Lichtenstein. good sources. Fatty fish—such as they’ll develop a liking for them, too. “Initially, when we recommended salmon, sardines, and herring—are “It’s important for parents to cutting total fat, we did not rich in unsaturated fats, too. expose children to a variety of tastes anticipate people would replace it Large studies have found that early on but realize that it often with fat-free foods, like cookies, replacing saturated fats in your diet takes several attempts to get a child crackers, and ice cream, made with with unsaturated fats can reduce to eat such foods,” Bremer says. refined grains and sugar,’” says your risk of heart disease by about “Don’t give up too soon.” Lichtenstein. “It is what we refer to the same amount as cholesterol- The key to good health is eating as an unanticipated consequence.” lowering drugs. a well-balanced diet with a variety of As scientists have learned, those foods and getting plenty of physical replacement calories matter. Studies activity. Focus on nutrition-rich have shown that replacing saturated whole foods without added sugars. fat with unsaturated fat reduces Definitions Get tips on healthy eating and weight the risk of heart disease. However, control at go.usa.gov/xEjmc. replacing saturated fat with simple carbohydrates, such as added sugar Saturated Fats and white bread, does not. Fats that are solid at room temperature; “There’s still this misconception found in butter, lard, full-fat milk and yogurt, full-fat cheese, and high-fat meat. Web Links that eating fat—any kind of fat—is For more about sugar and bad, that it will lead to heart attacks Unsaturated Fats sweeteners, go to: newsinhealth. or weight gain. That’s not true. Fats that tend to be liquid at room nih.gov/special-issues/eating/ People really should be encouraged temperature; found in oils, sweet-stuff to eat healthy fats,” says Dr. seafood, and nuts. 6 newsinhealth.nih.gov/special-issues

People should actively make foods. They have been shown to More research is needed to unsaturated fats a part of their diet, raise the risk of heart disease. understand which foods that contain Sacks says. You don’t need to avoid Since 2015, the U.S. Food and saturated fats may influence the healthy fats to lose weight, he adds. Drug Administration has taken body in a good way. In an NIH-funded study Sacks steps to remove artificial trans fats led, called the POUNDS LOST trial, from the food supply. Most trans fats Individual Needs people who ate higher-fat or lower- now in food come from the small fat diets had similar rates of weight amounts found naturally in animal Researchers know that there are big loss. They were also both successful products, like meat and butter. differences in how people’s bodies at keeping the weight off. Experts already recommend that react to different types and amounts “Low-fat diets have the same people limit their intake of animal of fat. But they still don’t know why. effect on body weight gain or fats. “So that takes care of those Studies have found that genes aren’t as higher-fat diets or trans fats as well,” Lichtenstein says. likely responsible, Sacks explains. higher- diets,” he explains. As for saturated fat, it’s Lichtenstein and Krauss are both “For weight loss, it’s about getting complicated. Not all of the saturated studying how the microbes that live a handle on whatever foods in your fat in the bloodstream comes in the gut interact with dietary fats. diet are giving you excess calories.” from the saturated fat that we eat, The makeup of the microbiome—all explains Dr. Ronald Krauss, who the microorganisms that normally live in the body, mainly in the gut— Replacing “Bad” Fats studies cholesterol at the UCSF Benioff Children’s Hospital Oakland. can differ widely between people. So are there fats you should avoid? Instead, it’s produced when the body It may turn out that different types Only a few years ago, doctors still breaks down simple carbohydrates of gut bacteria produce different had to advise people to avoid and sugars. That’s one reason why compounds from fats. These so-called trans fats in their diets. replacing saturated fat in the diet compounds could then affect the These largely manufactured with simple carbohydrates doesn’t body in different ways, Lichtenstein fats could be found in things like reduce the risk of heart disease. explains. Or different types of margarine and many processed Nutrition experts still recommend fats could promote the growth of that people minimize the amount different bacteria in the gut, which of saturated fat in the diet. But may then have varying effects on health. Wise Choices researchers are now looking at whether the type of food that “We just don’t know yet, but there Choosing Fats saturated fat is found in matters. is tremendous interest in trying For example, the influence of plant- to understand the role of the gut based saturated fats, such as those in microbiome in human health,” ●● Eat plant-based foods. Plants can coconut and palm oil, is still unclear she says. contain healthy fats, as well as If there’s one thing that the important vitamins and minerals. and being researched further. Recent studies suggest that some research has shown, it’s that the ●● Include plant oils in your diet. full-fat dairy products, such as science of diets is very complex. Healthy choices include canola, yogurt, may actually have benefits Experts have moved away from peanut, olive, safflower, soybean, for the heart, Krauss says. focusing on single nutrients—such sunflower, corn, and oils. Krauss and his colleagues recently as fat—by themselves. Instead, Sacks ●● Replace foods containing ran a small study looking at the says, researchers now talk about saturated fats (like butter or effects of replacing some of the healthy dietary patterns: ways of lard) with healthier unsaturated sugar allowed in the DASH diet with eating that take all aspects of the fat options. saturated dairy fats. The DASH diet diet into account. Learn more about ●● Limit fatty red meat. Instead, eat was developed by NIH to help lower healthy dietary patterns at health. more fish, poultry, or lean meats. blood pressure. gov/dietaryguidelines. ●● Reduce sugars and replace Participants who ate saturated processed grains, such as white dairy fat instead of sugar had less bread and white rice, with whole of a fat called triglycerides in their grains and brown rice. The body bloodstream. The higher-fat diet Web Links can use simple carbohydrates to was also as effective at lowering For more about dietary fat, go to: make saturated fats. blood pressure as the standard newsinhealth.nih.gov/special- DASH diet. issues/eating/skinny-fat newsinhealth.nih.gov/special-issues 7 The Salty Stuff Salt, Blood Pressure, and Your Health

Salt is essential to our body’s fluids. That’s likely why we evolved to enjoy its taste. On the other hand, anyone who’s gotten a mouth full of seawater knows that too much salt tastes terrible. Maybe your body’s trying to tell you something. It turns out that too much salt can lead to a host of health problems. Dietary salt, or table salt, is made from two chemical elements: sodium and chloride. That’s why its chemical name is sodium chloride. It’s the sodium part that’s been tied to health problems. But since most of the sodium we ingest is from salt, it’s difficult to separate the effects of salt and sodium in many studies.

Health Effects “The best-known effect of sodium on health is the relationship between sodium and blood pressure,” explains Dr. Holly Nicastro, an NIH nutrition research expert. Dozens of studies, in both animals and people, pressure below. blood pressure. In light of this, she have linked a higher salt intake with Some research also suggests says, “It’s really important for the higher blood pressure. Reducing salt that excessive sodium intake majority of U.S. adults to reduce intake, on the other hand, lowers increases the risk of . their blood pressure.” blood pressure. Scientists continue to investigate Blood pressure is the force of this possible connection. How Much Salt? blood pushing against the walls of Researchers do know that not everyone is equally sensitive to salt. Experts recommend that adults take arteries as the heart pumps out “From our experiments, we know in less than 2,300 milligrams (mg) of blood. When this pressure rises—a sodium a day—that’s what’s in about condition called high blood pressure, there’s lots of variation in the blood pressure response to sodium intake,” 6 grams of salt, or about a teaspoon. or —it can damage People with high blood pressure the body in many ways over time. Nicastro says. Certain groups of High blood pressure has been linked people see greater reductions in blood pressure when they lower their to heart disease, , kidney failure, and other health problems. salt intake: African-Americans, There are two blood pressure older adults, and people with blood Definitions numbers, and they’re usually pressure above normal. “Within those groups, there’s written with one above or before Arteries the other. Systolic, the first, is the a lot of variation between people,” Nicastro says. But about 1 in 3 adults The vessels that carry blood from your pressure when the heart beats, heart throughout your body. pumping blood through the arteries. nationwide has high blood pressure Diastolic is the pressure when the right now. Another third have Stroke heart is at rest between beats. The elevated blood pressure, meaning When normal blood flow to the brain is numbers 120/80 mmHg are the ones their numbers are high enough to stopped, usually by ruptured or blocked you should aim to keep your blood put them at risk to develop high blood vessels. 8 newsinhealth.nih.gov/special-issues should shoot for 1,500 mg. But right from a decline in heart disease, and Try to select foods, she advises, with now, American adults eat an average younger adults from fewer deaths. less than 5% of the daily value of salt of about 3,600 mg of sodium per day. per serving. Dr. Kirsten Bibbins-Domingo Reducing Salt at the University of California, San Francisco, led an NIH-funded Some countries have tried to lower “In terms of advice, I think study that used computer modeling salt intake using various strategies, the best guidance we to explore the effects of a modest such as working with industry to reduce the salt content in processed have is for people to pay reduction in salt intake in the United attention to nutrition facts States. The researchers found that foods, requiring labels on ready-to- reducing salt intake by 3 grams per eat foods, and educating the public. on the labels.” day (1,200 mg of sodium) could cut The UK achieved a 15% reduction in salt consumption between 2003 and the number of new cases of heart Making Changes disease each year by as many as 2011. During this time, deaths from 120,000, stroke by 66,000, and heart stroke fell by 42% and from heart Even small salt reductions can affect attack by nearly 100,000. It could disease by 40%. your blood pressure. If you can’t find also prevent up to 92,000 deaths But wouldn’t we miss the taste? a low-salt alternative to a particular each year. “Several studies have shown that as food, it still helps to pick something All segments of the population you gradually reduce sodium intake, that’s lower than what you’re already would benefit, with African- you lessen your desire for salty food,” consuming. Americans having the greatest Nicastro says. And surveys of people “You can find remarkable improvements overall. Women across the UK found that most variation in the amount of salt would particularly benefit from people didn’t notice any difference in across major brands of food,” reductions in stroke, older adults the taste of their food. Bibbins-Domingo says. “Even “A very modest decrease in the without choosing something labeled amount of salt, hardly detectable ‘low sodium,’ you can often find a in the taste of food, can have lower-sodium alternative.” Wise Choices dramatic health benefits for the Beyond salt, a healthy eating Cut Back on Sodium U.S.,” Bibbins-Domingo stresses. plan can help keep your blood The salt we add to our food pressure under control. Check out actually accounts for about 10% NIH’s Dietary Approaches to Stop ●● Look at Nutrition Facts labels and of our salt consumption. Most of Hypertension (DASH) eating plan try to choose prepared foods that the salt we eat comes in processed at go.usa.gov/xEjmy. Other lifestyle have less than 5% of the Daily Value foods from stores, restaurants, and measures can help you keep your of sodium per serving. dining halls. You may already know blood pressure down, too. Lose ●● Use fresh poultry, fish, and lean that fast food, cold cuts, and canned weight if you’re or obese. meat, rather than canned, smoked, foods tend to have a lot of salt. Get regular physical activity. Quit or processed. “Many people don’t realize that smoking. Manage your stress. The ●● Choose fresh or frozen vegetables a lot of our salt is from breads and more of these steps you take, the that have no added salt. cereals,” Bibbins-Domingo says. more likely you’ll be to avoid related Studies have found that about 15 to health problems. ●● Rinse canned foods to remove 20% of the sodium in the average some of the sodium. Why not start now? Make small American’s diet comes from changes at first, and then keep ●● Add less salt—or none—when products, such as breads, cereals, working to gradually lower your cooking. crackers, and chips. family’s salt intake. ●● Use reduced-sodium bouillon, “In terms of advice, I think the dressings, and sauces like soy sauce. best guidance we have is for people to pay attention to nutrition facts ●● Use fresh herbs and buy spices and blends without added salt. on the labels,” Nicastro says. “The Web Links percent daily value is a better guide ●● Cook at home instead of eating out, For more about salt, go to: than the language that’s used on food newsinhealth.nih.gov/special- when possible. But when eating labels like ‘low-salt.’ These labels issues/eating/salty-stuff out, ask that no extra salt be added can be confusing, because they have to your food. very defined technical meanings.” newsinhealth.nih.gov/special-issues 9 Rough Up Your Diet Fit More Fiber Into Your Day

Fiber—you know it’s good for you. labels. Many foods But if you’re like many Americans, contain both. And you don’t get enough. In fact, most of both types have health us get about half the recommended benefits. Experts amount of fiber each day. suggest that men aim is found in the plants for about 38 grams you eat, including fruits, vegetables, of fiber a day, and and whole grains. It’s sometimes women about 25 grams. called bulk or roughage. You’ve Unfortunately, in the probably heard that it can help United States, we with digestion. So it may seem odd take in an average of that fiber is a substance that your only 16 grams of fiber body can’t digest. Much of it passes each day. through your digestive system practically unchanged. Health Benefits “You might think that if it’s not digestible, then it’s of no value. Some of fiber’s greatest But there’s no question that higher benefits are related intake of fiber from all food sources to cardiovascular is beneficial,” says Dr. Joanne Slavin, health. Several large a nutrition scientist at the University studies have found that of Minnesota. people who eat the most fiber had a lower risk for heart disease. affects the large intestine, or colon. Types of Fiber Fiber may also play a role in Different types of fiber can affect “You might think that if reducing the risk for type 2 diabetes, your health in different ways. That’s the most common form of diabetes. why the Nutrition Facts labels on it’s not digestible then it’s Fiber in the intestines can slow some foods may list two categories of no value. But there’s the absorption of sugar, which of fiber: soluble and insoluble. no question that higher helps prevent blood sugar from spiking. “With diabetes, it’s good to Soluble fiber is found in , beans, intake of fiber from all peas, and most fruits. Insoluble keep glucose levels from peaking fiber is found in bran and food sources is beneficial.” too much,” explains Dr. Gertraud some vegetables. Some soluble fiber is broken High fiber intake—particularly down by the complex community soluble fiber—seems to protect of bacteria and other microbes against several heart-related Definitions that live in the human gut. These problems. “There is evidence that microbes, called gut flora or high dietary fiber consumption Cardiovascular microbiota, help with our digestion. lowers ‘bad’ cholesterol The system of heart and vessels that Emerging research shows they can concentrations in the blood and circulates blood through the body. affect our health in various ways. reduces the risk for developing Studies suggest that they may play heart disease, stroke, and high blood Cholesterol a role in obesity, type 2 diabetes, pressure,” says Dr. Somdat Mahabir, A waxy, fat-like substance that your body colon cancer, and other conditions. a nutrition and disease expert with needs to function. However, a high level Researchers are now looking at NIH’s National Cancer Institute. in the blood is a major risk factor for heart disease. how different types of dietary fibers Fiber can help relieve constipation affect the —and how and normalize your bowel Type 2 Diabetes that, in turn, affects our health. movements. Insoluble fiber is often A disease in which blood levels of But soluble and insoluble fiber used to treat or prevent constipation glucose—a type of sugar—are too high. aren’t always listed separated on and diverticular disease, which 10 newsinhealth.nih.gov/special-issues

Maskarinec of the University and keep your weight in check. generally contain isolated soluble of Hawaii. Your weight is another area fibers, such as inulin, polydextrose, In an NIH-funded study, where fiber might help. High-fiber or maltodextrin. These isolated Maskarinec and her colleagues foods generally make you feel fibers are included in the product followed more than 75,000 adults fuller for longer. Fiber adds bulk label’s list of ingredients. for 14 years. Consistent with other but few calories. “In studies where However, the health benefits of large studies, their research found people are put on different types isolated fibers are unclear. Research that diabetes risk was significantly of diets, those on the high-fiber suggests they may not have the same reduced in people who had the diets typically eat about 10% fewer effects as the intact fibers found in highest fiber intake. calories,” Slavin says. Other large whole foods. For instance, there’s “We found that it’s mostly the studies have found that people with little evidence that isolated fibers fiber from grains that protects high fiber intake tend to weigh help lower blood cholesterol. They’ve against diabetes,” Maskarinec less—although that may be because also shown inconsistent effects on says. However, she notes that while their diets are healthier. the regularity of bowel movements. high fiber intake may offer some Scientists have also looked into On the plus side, some studies protection, the best way to reduce links between fiber and different suggest they might boost the growth your risk of diabetes is to exercise types of cancer, with mixed results. of good bacteria in the gut. For example, there is evidence that a high intake of dietary fiber may “The focus should be reduce the risk for colon cancer and Wise Choices colon polyps. more on eating diets Tips to Get More that are rich in whole Fiber in Your Diet A Fiber-Rich Diet grains, , beans, Experts say that the type of fiber vegetables, fruits, nuts, you eat is less important than ●● and seeds to get the daily Bulk up your breakfast. Choose a making sure you get enough overall. high-fiber cereal (5 or more grams fiber requirement.” per serving) or make a bowl of “In general, people should not oatmeal and top it with nuts and be too concerned by the specific fruit. type of fiber,” Mahabir says. “The The bottom line is that most of us focus should be more on eating need to fit more fiber into our day, no ●● Switch to whole grains. Look for diets that are rich in whole grains, matter what the source. “It would be bread that lists whole-grain flour great if people would choose more as the first ingredient. Experiment legumes, beans, vegetables, fruits, with ; wild or brown rice; nuts, and seeds to get the daily foods that are naturally high in quinoa; whole wheat pasta; fiber requirement.” fiber,” Slavin says. and bulgur. Whole grains, fruits, and Increase your fiber intake gradually, so your body can get used ●● vegetables are also packed with Add a non-starchy vegetable. to it. Adding fiber slowly helps you Keep a bag of frozen mixed vitamins and other nutrients, so vegetables, spinach, or broccoli experts recommend that you get avoid gas, bloating, and cramps. florets for a quick addition to any most of your fiber from these natural Eat a variety of fruits, vegetables, pasta sauce or rice dish. Start sources. “Unfortunately, a lot of whole grains, and nuts to add a mix dinners with a tossed salad. people tend to pick low-fiber foods. of different fibers and a wide range of nutrients to your diet. A fiber- ●● Don’t forget legumes. Try peas, They go for white bread or white different kinds of beans (pinto, rice. Most of the processed rich diet can help your health in kidney, lima, navy, and garbanzo), foods—foods that are really many ways. and lentils. convenient—tend to be low in fiber,” says Slavin. ●● Snack on fruit, nuts, and seeds. Grab a piece of fruit such as an For people who have trouble apple, pear, or banana. Keep some getting enough fiber from natural Web Links almonds, sunflower seeds, and sources, store shelves are filled For more about fiber and health, go pistachios handy. Low-fat popcorn with packaged foods that tout to: newsinhealth.nih.gov/special- or sliced vegetables and hummus added fiber. These fiber-fortified issues/eating/rough-up-your-diet also make a great snack. products include , ice cream, cereals, snack bars, and juices. They newsinhealth.nih.gov/special-issues 11 Better Nutrition Every Day How to Choose Healthier Foods and Drinks

We make countless decisions every and water. day, both big and small. When it Some foods and comes to deciding what to eat and drinks should feed our families, it can be a lot be consumed easier than you might think to make less often. These smart, healthy choices. It takes just include white a little planning. bread, rice, and The foods and drinks we put into pasta; granola; our bodies are our fuel. They provide pretzels; and fruit us with energy and nutrients—like juices. Others vitamins, minerals, and — are best to have that our bodies need to function only once in a and thrive. Research shows that while—like french healthy food and drink choices are fries, doughnuts especially important for children’s and other sweet growing bodies and minds. Healthy baked goods, hot choices have both immediate and dogs, fried fish and long-lasting benefits for you and chicken, candy, your family. and soda. “My best advice is for parents “Healthier diets to be good role models by eating don’t have to cost healthy and being physically active more, provided that with their children,” says Dr. Holly you have the right attitude, make the spreads, such as hummus,” Nicastro Nicastro, a nutritionist at NIH. right food choices, and try to cook at says. “Pack vegetables such as “Keep healthy foods around the home,” says Dr. Adam Drewnowski, carrots, snap peas, and cucumbers house for meals and snacks. Involve a nutrition expert at the University or any fresh fruit that’s currently in children in the meal planning and of Washington in Seattle. With some season. Teens can learn to pack their cooking, and they will be more likely planning, he says, you can prepare own lunches with a healthy variety to eat the meals.” meals that are tasty, affordable, and of foods.” “Parents can begin teaching nutrient rich. their children about healthy eating Get the whole family to help slice, With some planning, you from the day they are born,” says dice, and chop. NIH has developed Dr. Donna Spruijt–Metz, whose several resources to help you learn can prepare meals that research at the University of how to improve your eating habits are tasty, affordable, and Southern California focuses on (see the Links box in the online nutrient rich. preventing and treating obesity version of this story). You might be in minority youth. “Setting a good surprised how easy healthy cooking example is very important.” and snacking can be. If your kids buy lunch, talk to them about making healthy choices when buying food from the school Healthier Choices Outside the Home cafeteria and vending machines. All foods and drinks can fit into These days, much of our food “Parents should encourage their a healthy diet. But when making isn’t eaten at home. It’s eaten on the children to choose the important choices for you or your family, try go. One easy way to get the nutrients food groups for lunch: a lean protein, to choose ones that have lots of you need is to pack healthy lunches— fruit and vegetable, whole grains,” nutrients and aren’t too high in sugar, both for yourself and your kids. Nicastro says. “If a salad bar is fats, and calories. These include “You can work with your child available, this is a great opportunity fruits; vegetables; whole-grain to make a lunch using whole- for kids to make their own salad cereals, breads, and pastas; milk, grain bread, wraps, or pita pockets with vegetables, lean protein, yogurt, and other dairy products; fat- filled with lean meats or cheese, and fruit.” trimmed and lean meats; fish; beans; vegetables, and nut butters or If you have a busy day with your 12 newsinhealth.nih.gov/special-issues family planned, pack healthy snacks resource to help you compare foods in a small cooler or tote bag before and drinks. It can help you confirm Take time to build healthy you leave. Consider water, fresh whether products marked with fruit, veggies, and low-fat cheese healthy-sounding terms really are eating decisions into sticks. Pack small portions of healthy. For example, “low-fat” foods every aspect of your unsalted nuts, whole-grain crackers, aren’t necessarily healthy; they can family’s life. or a low-sugar cereal. be very high in sugar and calories. Fast-food restaurants can also be Use the Nutrition Facts label to to find healthy foods in their a challenge, but sometimes fast food help guide you to limit the nutrients neighborhoods. is your only option. At restaurants, you want to cut back on, such as For instance, in some neighbor- use the menu labels and information sodium or added sugar. You can also hoods, people have joined together about calories and other nutrients use it to make sure you’re getting to tend community garden plots. to make healthier food and beverage plenty of the nutrients you need, “Learning to garden, planting rooftop choices. Healthy choices can include such as calcium and iron. gardens, box gardens, or small plant- salads, sliced fruit instead of french ers can provide some easy growing fries, and grilled options instead “Food provides our bodies veggies like tomatoes right at home,” of fried. with needed nourishment. Spruijt–Metz says. “Another possi- Teaching children to read bility is finding a fruit and vegetable Using Labels truck that would be willing to come When you’re grocery shopping, labels while shopping as to the neighborhood.” the Nutrition Facts label is a great they get older is a good Take time to build healthy eating way to help them learn to decisions into every aspect of your family’s life. If you’re a parent or shop for healthy foods.” guardian, start talking with kids Wise Choices at an early age about health and Tips for Eating Out When reading the label, start at nutrition. And practice what you the top. Look at the serving size. preach. Make healthy food and drink ●● Choose foods that are steamed, Next, look at the calorie count. Then choices yourself so you can set a broiled, baked, roasted, poached, move on to the nutrients, where it good example for your kids. or lightly sautéed or stir-fried. lists the amount and daily values “Food provides our bodies with ●● Ask for food without butter, gravy, experts recommend. needed nourishment. Teaching or sauces. Remember that what you might children to read labels while eat or drink as one portion can be shopping as they get older is a good ●● Ask for salad dressing on the side multiple servings. For example, way to help them learn to shop for and use only some of it. if you eat one bag of chips but the healthy foods,” Spruijt–Metz says. ●● Pick drinks without added label says there are three servings “Teaching them to cook simple, sugar, such as water, milk, and in a bag, you need to multiply all the tasty, and healthy meals when unsweetened tea or coffee. Order numbers on the label by three to find they’re young is a skill that will stay regular coffee or tea instead of out how many calories you just ate. with them throughout their lives.” high-calorie specialty drinks. ●● Trim visible fat from meats and Working Together remove skin from poultry. Web Links Sometimes it can be hard to find ●● Share your meal or take half home For more about healthy food and healthy food and drink choices for later. drink choices, go to: newsinhealth. when shopping locally. People nih.gov/special-issues/eating/ ●● Choose fruit or another healthy in some communities have been better-nutrition-every-day option for dessert. working together to make it easier

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