25 grams is the equivalent of about one drink:
One twelve ounce beer
One 5 ounce glass of wine
One 1 ounce shot of spirits
Give yourself 1 point for between 5 & 25 grams per day (between 10 & 50 grams per day for men).
Give yourself 0 points for less than between 5 & 25 grams per day (between 10 & 50 grams per day for men).
Give yourself 0 points for more than 25 grams per day (50 grams per day for men).
Most people think of olive oil when they think of the Mediterranean diet, but it is the ratio of unsaturated to saturated fats that is most important.
In most studies the ratio of saturated to unsaturated fat is higher.
A ratio of 1.6 to 1, with consumption of higher levels of unsaturated fats, adds a point to the score. The Mediterranean Diet is especially high in monounsaturated fat.
Healthy fats include…
Olive oil
Canola oil
Grapeseed oil
Avocado oil
Less healthy fats include…
Hydrogenated vegetable oil
Stick or hard margarines
Butter
Lard
Vegetable shortening
Give yourself 1 point for greater than the optimum ratio of greater than 1.6 to 1 for healthy fats to less healthy fats.
Give yourself 0 points for less than the optimum ratio of greater than 1.6 to 1 for healthy fats:less healthy fats.
We know that most all nuts are really good for you, but in one study of pistachios a group of 44 men and women followed a diet where 20% of their calories consumed came from pistachios. When compared to a control group eating a diet without pistachios, neither group gained or lost weight, but the pistachio group had excellent results in the area of their cholesterol profile: their total cholesterol was down, their HDL levels (the good stuff) were up by about 25%, and their LDL levels (the bad stuff) was reduced as well. (Nutr Met & Card Dis. 2006;16:202-209)
While avocados are high in fat (mind you, good monounsaturated fats), research has shown that there’s no risk of weight gain as long as they are used as the fat source in a calorie controlled diet. (Nutr 21 (2005) 67-75) That study did not show a change in cholesterol either way but there have been research articles supporting an improvement in the serum cholesterol profile in those folks eating avocados.
The most important study dates to 1996 where subjects were given an avocado rich diet and those healthy subjects in the test group showed a 16% decrease of total cholesterol level. Those in the study with high cholesterol showed a significant decrease of serum total cholesterol (17%), LDL-cholesterol (22%) and triglycerides (22%), and increase of HDL-cholesterol (11%) levels with the avocado diet, while no significant changes were noticed with the control diet. (Arch Med Res 1996 Winter;27(4):519-23)
We know that good quality fatty fish helps with cholesterol, but what about the oil that it is cooked in?
Researchers in the United Kingdom (Nutr 2006;22:1012-1024) recruited 134 men and women between the ages of 35 and 65 whose Body Mass Index was between 25 and 40 (overweight to obese), but otherwise healthy, to participate in a study comprised of a control group and four intervention groups. All groups had their height and weight measured, as well as their blood drawn at 12-week intervals throughout the 24-week study to check their cholesterol scores, particularly their triglycerides.
The control group continued to eat their normal diet throughout the study. The intervention groups received two servings of oily fish (such as salmon or mackerel) or white fish (cod, tuna, or shrimp) per week, along with cooking oils and spreads made of either sunflower oil or canola oil. The subjects completed dietary records on a regular basis to track their intake of the intervention foods. All groups contained about equal numbers of men vs. women and similar BMI levels.
Sometimes the study length makes a difference as well as what is being studied. The investigators found that the amount of time on the intervention diets had an impact on the effects of the change in diet. At 12 weeks, those on the oily fish and canola oil intervention had lower triglyceride levels than the white fish and sunflower oil group. At 24 weeks, however, the control group, the oily fish and canola oil group, and the oily fish and sunflower oil groups all had significantly lower triglycerides than the white fish and sunflower oil group.
So eating oily fish is key and not what you cook it in. In this and other studies, eating more oily fish such as salmon or mackerel has been shown to be better for you than white fish like tilapia or trout, but in this study it took a little more time to show that benefit in those using the sunflower oil to cook the oily fish.
One study that compared a “diet portfolio” of foods that have been shown in other studies to improve cholesterol. These were soy protein foods (such as soy milk and soy burgers), almonds, viscous fiber from oats, barley, psyllium, and the veggies eggplant and okra.
This diet made up of the “diet porfolio” of foods was compared head to head with a low saturated fat diet AND the drug lovastatin (brand name: Mevacor). LDL cholesterol was reduced a similar amount in the group eating the portfolio diet and those taking the drug. (Am J Clin Nutr 2005;81:380-7) That’s amazing and fantastic that diet can have as much of an effect on your cholesterol as taking medication.
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There is a pretty clear link between high serum cholesterol and heart disease. “Serum” cholesterol means the blood test that your doctor performs. It’s not just the total cholesterol that we care about but the lipid panel. Lipids are fats and the various types of fats that we measure are the High Density Lipoprotein (HDL), Low Density Lipoprotein (LDL) and triglycerides. The key is there is a difference between these lipids and the cholesterol we consume.
For most of us dietary cholesterol, the cholesterol we eat, has not been clearly linked with any effect on our serum cholesterol. Quite simply, it appears that consuming cholesterol is not really something that we need to focus on. For instance, one food that has never been shown to have an effect on cholesterol is eggs. That’s right, eggs. In a recent article in Circulation (2008;117: 512-516) researchers found no association between the amount of eggs the subjects ate and any change in their total cholesterol, HDL cholesterol, or ratio of total cholesterol to HDL cholesterol.
How can you lower your cholesterol? For the most part we don’t know the exact mechanisms for lowering cholesterol. Fiber is one nutrient that does help lower cholesterol, and it appears that the mechanism has to do with fiber’s effect on the absorption of dietary cholesterol and other fats. You likely already know that foods that are high in fiber, especially those with soluble fiber such as beans, oat bran, oatmeal and rye, are clearly shown to improve cholesterol profiles. That’s not to say that insoluble fiber, such as that found in fruits, whole grain products like whole wheat flour, whole grain breads and pastas, as well as cereal grains like rice, wild rice and seeds, should be ignored. These guys are great too!
We know that good quality oils and fats that are high in monounsaturated fats change cholesterol profiles for the better, but there’s more to it than the fat itself. In the case of olive oil many of the flavonoids, polyphenols and other antioxidants are what appear to affect cholesterol. These are similar to compounds in such things as chocolate, red wine and fruits that help change the composition of the lipids in the body.
There are, however, a few foods that have an effect on cholesterol that may surprise you:
Yep, you read that correctly, chocolate. In one study 28 healthy males between 18 and 20 years old were given 105 grams of milk chocolate per day for 14 days. They showed a decrease in total cholesterol and LDL cholesterol. (Clin Dev Immunol 12, 11 – 17) Interestingly, the researchers also showed a mild drop in blood pressure. There have been numerous other studies showing that chocolate increases the good (HDL) cholesterol. (Am J Clin Nutr 74, 596 – 602) (J Am Coll Nutr 23, 197 – 204)
Yum. A cup of hot cocoa! In one study 160 adults were given varying “doses” of cocoa over a 4 week period. Blood samples were collected at baseline and four weeks. They found that oxidized LDL concentrations decreased in the low-, middle-, and high-cocoa groups compared with baseline. (This is not LDL cholesterol but the oxidation process of the LDL “packet” is now associated with artherosclerosis.)
When they looked at those participants who had higher cholesterol levels at baseline they found that their LDL cholesterol decreased and the plasma HDL cholesterol concentration increased, relative to baseline in the low-, middle-, and high-cocoa groups. The results suggest that antioxidant substance such as polyphenols derived from cocoa powder may contribute to a reduction in LDL cholesterol, an elevation in HDL cholesterol, and the suppression of oxidized LDL. (J Nutr 137, pg 1436-1441)
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Back in the 1970’s and 80’s eggs got a really bad rap – and not for very substantial reasons. Much of what happened in the late 1960’s that laid the groundwork for the egg’s poor reputation wasn’t based on sound science, but over the last 30 years research has shown that for most people, dietary eggs and cholesterol is not a problem. The truth is that the amount of trans fat and saturated fat in your diet has much more impact on your cholesterol levels – and therefore your risk of heart disease – than the amount of cholesterol you eat.
We do know that there are folks who are considered “hyper-responders” to cholesterol consumption, meaning they have a greater increase in their blood cholesterol after consuming dietary cholesterol (although not a tremendous increase). About 1/3 of us might be more sensitive. (Am J Clin Nutr 1985;42:42 1-431)
Even so, in large studies looking at cholesterol consumption (especially eggs) it doesn’t seem to matter all that much.
As far back as 1999 there was strong evidence that eggs were not an issue. Dr. Frank Hu and his colleagues looked at the combined data from two very large studies with over 37,000 participants (JAMA 1999;281(15):1387-1394). Of the 2,626 reported cases of heart disease and stroke, the researchers found no evidence of a link between egg consumption and cardiovascular disease. There conclusion stated, “These findings suggest that consumption of up to 1 egg per day is unlikely to have substantial overall impact on the risk of CHD or stroke among healthy men and women.” When they looked at diabetics, there was some suggestion that diabetics might be at a higher risk with egg consumption.
There are also reports providing evidence that having eggs as part of a calorie restricted diet resulted in improved weight loss (both regular and low-carb diets). These are small studies but appear effective (Int J Obesity (2008) 32, 1545-1551).
A recent study addressed eggs and heart disease, high blood pressure as well as congestive heart failure (Circulation 2008;117: 512-516). Researchers separated participants’ egg consumption into 6 levels: <1 per week, 1 per week, 2-4 eggs per week, 5-6 per week, 1 daily, and 2 or more eggs per day. Those levels of egg consumption were correlated with that of the subjects who experienced heart failure, heart attacks, or high blood pressure.
They found that after controlling for a number of variables, including Body Mass Index, physical activity and smoking, those subjects eating less than 6 eggs per week saw no increase in their risk of heart failure. On the other hand, those who ate an egg every day had a 28% increase in their risk of heart failure, and those who ate 2 or more eggs per day increased their risk by 64%.
Further, when the researchers looked at the smaller group of subjects who provided cholesterol levels, they found no association between the number of eggs the subjects ate and their total cholesterol, HDL cholesterol, or ratio of total cholesterol to HDL cholesterol.
Eggs are pretty good for you, but as the old saying goes, too much of a good thing is too much of a good thing. This doesn’t mean you should eat eggs every day, but at the same time they appear unlikely to do you much harm in moderation (as with most foods). Better to look at the amount of fat and saturated fats in your overall diet than to obsess over how many eggs you eat.
Relax and enjoy your eggs without guilt!
Here are some healthy egg recipes for you to use to enjoy your guilt-free eggs:
Healthy Egg Salad
Curried Egg Salad | Low Sodium Version
Egg Salad with Olives
Egg Salad with Roasted Onion
Eggs Benedict
Polenta and Eggs
Scrambled Eggs
Nuts and seeds are great for you.
While nuts and seeds contain a lot of calories, they are the best quality calories and are high in unsaturated fats, especially monounsaturated fat. Nuts have been shown to be very satisfying and this makes them a great choice for snacking. Instead of potato chips or crackers, have nuts. There’s great research that shows you won’t gain weight eating the nuts, while eating potato chips is clearly linked with disease (Am J Clin Nutr 2006;83(2):284-90).
In one study researchers found that participants who were eating 5 or more 1-ounce servings of nuts per week were 26% less likely to die from any cause, including cardiovascular disease, cancer, or stroke. That’s huge! Even more interesting is that those who reported eating just a little less – between 1 and 4 servings per week – reduced their risk of death by about 15%. (Am J Clin Nutr 2015;101(2):407-12)
In a follow up study using similar data, researchers found that compared to those who did not eat nuts at all, eating nuts (regardless of amount) made the participant 7% less likely to die of any cause. (NEJM 2013;369(21):2001-11) That may seem less than interesting, but look at what happens as the amount of nuts eaten each week increases:
Those who ate 1 ounce of nuts less than once a week were 11% less likely to die of any cause.
Those who ate 1 ounce of nuts 2 to 4 times per week were 13% less likely to die of any cause.
Those who ate 1 ounce of nuts 5 to 6 times per week were 15% less likely to die of any cause.
Those who ate 1 ounce of nuts 7 or more times per week were 20% less likely to die of any cause.
Even for those already following a Mediterranean Diet, increasing the amount of walnuts consumed has been shown to lower total and LDL (bad) cholesterol an extra 6% over their already healthy diet. Other studies on specific varieties of nuts show similar positive effects. For example, and one study showed similar improvement in cholesterol profiles when participants ate 20% of their recommended calories in pistachios. Studies with walnuts and almonds show the same results.
One important study shows that nuts added to a Mediterranean Diet dramatically reduced the risk of developing metabolic syndrome (a grouping of conditions including diabetes, hypertension and high cholesterol).
People who snack on nuts tend to reduce the number of calories they eat at regular meals (J Nutr Met doi:10.1155/2011/357350). In another study of those already on a Mediterranean diet, adding walnuts resulted in an additional 4% decrease in total cholesterol. Research on almonds shows that adding 3 ounces of almonds per day for 9 weeks resulted in as much as a 10% drop in cholesterol. To make it even better, nuts and seeds are chock full of antioxidants and Vitamin E as well as magnesium, copper, plant sterols, protein, and fiber. In look at tree nuts – and specifically walnuts – a study showed that the more walnuts a woman ate, the lower her risk of developing type 2 diabetes. (J Nutr 2013;143(4):512-518)
There is similar proof about the benefits of eating fruit. A great study looked at whether an apple a day actually does keep the doctor away (Am J Clin Nutr 2002;76(3):560-68). Researchers in Finland were looking at the effect of diet and antioxidants on different diseases. They were trying to understand what types of antioxidants, such as flavonols and flavones, might offer protection against disease.
Their work showed that the more apples a person ate, the lower their risk of heart disease, diabetes, lung cancer and asthma. Another group showed the positive effects of apples against ongoing genetic damage. In both cases the researchers felt that it was the high antioxidant content in apples that made the difference.
I’ve written elsewhere about how great fiber is for you, and apples, like most fruit, have a lot of fiber. They have as much fiber as a slice of whole wheat bread, but only about 80 calories. This makes them the perfect snack. We know that people who fall into the “sweet snacker” category are a perfect match for fruit (Appetite 2006;47(1):107-10). One study showed that those folks who ate an apple were nearly as satisfied as when they ate a chocolate bar, but they felt much less guilty about eating the fruit.
In a very well designed study women eating fruit as snacks lost weight (an average of 2 pounds), while those women eating cookies gained a weight (about a pound, on average) (Appetite 2008;51(2):291-295).
Sweet and juicy, it’s important to have your fridge full of apples, grapes, oranges, pears, and other fruit so you are prepared. Fresh fruit is a better choice than fruit juice because the fruit has been shown to be much more satisfying than drinking a glass of juice.
Have as much fruit every day as you want. Like veggies, it’s hard to gain weight eating fruit. Have fruit with meals and for snacks when you’re craving something sweet. Keep nuts on hand for the times that you want a more savory snack. There’s no doubt that eating more of them (and less junk food) will help you be healthier.
Of the nine principles of the Mediterranean diet, meeting this requirement and earning that one point in the Mediterranean Diet Score is the easiest to do because you have to eat so few vegetables to get that score. The best part is that it’s the one thing you can’t get too much of. (You’ll never hear your doctor say, “Hmm, my lab tests show that you’ve been eating too many carrots.”) Even better, there are many classic American recipes using vegetables, from Cole Slaw to Creamed Spinach.
Much of the research on vegetables in the diet is focused on the antioxidants abundant in everything from asparagus to zucchini. It is now clear that that the vitamin, mineral and antioxidant benefits from vegetables can’t be gotten by taking a pill. (J Nutr http://www.nutritionj.com/content/6/1/10) (Am J Clin Nutr 2006;84(4):880-87)(JAMA 2009;301:52-62)(Cochrane D Sys Rev no. 2 art. no.:CD007176(2008)). Recent studies show no benefit from taking supplements, but getting the same vitamins from vegetables is pretty powerful: each additional serving of fruit and vegetables per day reduces your risk of heart disease by 4%. That’s huge! But it’s not just about heart disease. Putting more veggies on your plate has been shown to reduce the risk of multiple types of cancers. Add to this that research has also shown a clear weight loss benefit by eating more vegetables.
There are two ways to eat fewer calories. One is to eat smaller portions and the other to reduce the amount of calories in a particular dish. Health meets Food recipes use both of these approaches, enhancing the taste and satisfaction of a recipe by choosing lower calorie ingredients that maximize flavor. “Calorie density” describes the number of calories contained in a given amount of food. For example, 4 cups of air-popped popcorn has less than 100 calories, while 4 cups of french fries from McDonald’s would have over 2,700 calories. The french fries are more calorie-dense than the popcorn.
Reducing caloric density is a great strategy and it has been shown that people are just as satisfied with lower calorie recipes. For example, researchers at Johns Hopkins School of Public Health compared recipes made with ground beef with the same dishes made by replacing the meat with mushrooms.
They recruited 54 men and women of varying body mass index (normal, overweight or obese) to have lunch at the School of Public Health on eight occasions. At four of the lunches the subjects were served a meal of either lasagna, savory napoleon, sloppy joes, or chili that were all made with ground beef; on each of the other four occasions they were served the same meals, but with the same volume of mushrooms substituted for the ground beef. Each time the participants were asked to keep detailed records of what they ate later in the day, how hungry they felt, and how satisfied they felt with their lunch meals.
There were four possible variations on the meals:
1. A standard meal;
2. 75% of the calories of the standard meal but same weight;
3. Same calories as standard meal, but 75% of weight;
4. 75% of calories and 75% of weight as the standard meal
All three of the lower calorie variations of the standard diet saw the participants eating less: for all of the non-standard meals, the subjects were presented with smaller portions or reduced-calorie versions of their meals, or a combination of the two (smaller portion, lower calorie). However, the subjects found the dishes to taste as good and be as satisfying as the traditional recipes.
The researchers told their subjects that they were comparing the “acceptability” of mushrooms versus ground beef in the diet. They found that although the subjects knew that they had been served mushrooms instead of beef, they still rated meat and mushroom meals about the same in terms of how they tasted, whether the meals satisfied their appetite for lunch, and how satisfied they felt later in the day. Over the four days that participants ate a mushroom meal, they consumed an average of almost 1,500 fewer calories than they did over the four ground beef days. Each mushroom meal averaged about 310 calories, while the ground beef meal averaged about 730 calories.
On each individual day, eating mushrooms in their lunch meant consuming an average of 420 fewer calories than they did on days that they ate ground beef in their meals. (Note that losing 1-2 pounds per week means eating about 350 fewer calories per day!)
This supports many earlier studies by demonstrating that even if people know that they’re not eating the same version of the expected food, they’ll still behave as if they did — in terms of total calories eaten that day — if the food is the same volume and just as satisfying as the original. It is simple: getting more veggies in your diet means not only improving your Mediterranean diet score, it also means losing weight and still being really satisfied.
Maybe you are saying, “But I just don’t like vegetables.” But if you make a list, you will find that you do like some.
This is how you should get started. Make a list of what you do like. Make a list of recipes you love. For instance, of you like carrots, you might love Candied Carrots. Find the recipes you love, put the ingredients on your grocery list, and get what you need the next time you are at the grocery store.
Plan on an extra helping for dinner. Buy enough when you are at the grocery so that you can make extra. It’s just as easy to make double the servings of Green Beans Almondine as it is to cook a single batch. It won’t add many calories and they’ll fill you up. You’ll be healthier and there is excellent research to show that you’ll be far more satisfied. Choosing recipes that contain a lot of vegetables helps add flavor and volume to your meals. It is no coincidence that what New Orleanians call “the holy trinity” of onions, celery, and peppers is based in Mediterranean cuisines. It not only adds a lot of flavor to recipes, it also makes them healthier.
Keep in mind that vegetables aren’t just for dinner. You can pile as many veggies on your sandwich at lunch as you want: lettuce, tomatoes, cucumbers, green peppers, red peppers, onions, mushrooms, sprouts…. The list is endless and every day your sandwich will be an adventure.
Making vegetables part of your life as snacks is another great way to eat more. There’s fantastic research that shows how satisfying this can be. Simple changes in just one of the foundation areas of a Mediterranean style diet can have a profound impact on your weight and long term health. Make the produce section at the grocery store your first stop.
Over the last thirty years the media has disseminated literally thousands of columns on nutrition information and how to eat healthy. The problem is that there have been so many different (and often over-simplified) messages: avoid fat, avoid trans-fats, eat whole grains, avoid all carbohydrates, all meat is bad, all meat is good, sugar is bad, don’t eat anything white, only a vegan diet is healthy, we should eat like Neanderthals….
Some of that information is in fact mis-information: it comes from fad diets which are generally based on faulty science at best and much more often based on outright myth and pseudoscience. Add to the confusion the fact that nutrition science has been evolving in the last few years, and that health messages that are indeed founded on the best science available still do change over time. Between this and silly fad diets it can be hard to know what to believe.
That’s the bad news.
The good news is that there has been a tremendous amount of excellent research about diet and nutrition published in the last decade. We now have a great understanding of what works from studies of the Mediterranean style diet. “Mediterranean” simply refers to the people who live on the Mediterranean Sea, whose diets are higher in fruits and nuts, vegetables, legumes (beans and peas), and whole grains and cereals. They consume less red meats and poultry than we Americans do, and they eat more fish. They eat some dairy products, although much of the dairy is in the form of cultured products like cheeses and yogurt rather than drinking milk. That lower intake of poultry and red meats is coupled with a moderate consumption of alcohol, which is usually wine and drunk most often with meals. Olive oil is their main source of dietary fat, and they use far less of the more highly saturated fats like butter and lard.
The best way for you to think about this is to focus on these ingredients and that style or pattern of eating and not specific Mediterranean recipes. This style of eating and these ingredients have formed the basis for our recipes for years, and for the most part it adds up to fewer calories and better quality foods. That is, in essence, using the principles of the Mediterranean diet and applying them to the American kitchen by translating the recipes that you know and love into versions that taste just as good but are better for you. You’ll be surprised at how good healthier versions taste.
Before the year 2000 there had been a number of studies to suggest how healthy the Mediterranean Diet was, and in 2003 Antonia Trichopoulou and her colleagues reported on a large study that examined over 22,000 healthy adults in Greece. They found that those who more closely followed a Mediterranean-style diet had a significant reduction in their risk of death from heart disease and cancer. (NEJM 2003;348:2599-2608).
While there had been other studies, this was a much larger and more exhaustive look, with the researchers following participants over time. Dr. Trichopoulou and her colleagues analyzed the diets of those in the study for a year prior to the beginning of data collection. They then looked at nine dietary components of a Mediterranean diet. A value was assigned of either 1 or 0 for each dietary category: fruits and nuts, vegetables, legumes, whole grains and cereals, meat and poultry, fish, dairy, dietary fats, and alcohol. If a participant was found to have eaten a diet more favorably in each of the nine dietary components, they received a point in each of those categories. The maximum score for a perfect Mediterranean diet would be 9 and a score of 0 would indicate a more Western diet pattern. They also issued a lifestyle questionnaire that recorded physical activity.
The results were pretty amazing. Quite simply, those who had better scores lived longer and were healthier.
The best part is that small changes have a big effect. After analyzing the data, the researchers noted that a two point improvement (say from 5 to 7) in a Mediterranean Diet Score resulted in a 25% reduction in death from all causes. This would mean, for example, that by simply eating more vegetables and legumes you could markedly improve your health and live longer.
What about those 9 components of the Mediterranean diet? How has this been used in research and what does it mean for you?What makes up the Mediterranean diet score?
That study of over 22,000 Greeks determined a threshold amount for each component of the Mediterranean Diet. The following list details those thresholds and you can calculate your own diet score based on these amounts.
It is pretty simple. The scores have been adjusted for a 1,500 calorie per day diet for women and 2,000 calories for men. For instance, if you are a woman and consume more than 9 ounces of veggies by weight per day, on average over a week, you score one point. Eat less than that on average and you get zero. The best overall score is a 9 and the worst a zero.
Work through these 9 sections and see how you score. Keep track of your food intake for a week and score yourself on the average over the week. Even better, you’ll find that keeping a simple food diary can help you identify places where you can improve your score.
1. If you are female, do you eat more than 9 ounces of vegetables per day (11 ounces for men)?
4 ounces is…
about two medium carrots
about 8 medium spears of asparagus
about 1 cup sliced yellow squash or zucchini
about one 3 inch beet
about 1 1/4 cups chopped broccoli
Score:
1 point for more than 9 ounces female / 11 ounces male
0 points for less than 9 ounces female / 11 ounces male
2. Do you eat more than 1 3/4 ounces of legumes per day (2 ounces for men)?
1 3/4 ounces is…
about 1/4 cup canned chick peas
about 3 tablespoons peanut butter
about 1/4 cup raw lentils
about 1/3 cup canned kidney beans
about 1/3 cup roasted soybeans
and 2 ounces is about 2/3 cup frozen peas
Score:
1 point for more than 1 3/4 ounces female / 2 ounces male
3. Do you eat more than 8 ounces of fruit or nuts per day (9 ounces for men)?
8 ounces is…
1 large apple
2 medium bananas
Score:
1 point for more than 8 ounces female / 9 ounces male
0 points for less than 8 ounces female / 9 ounces male
4. Do you eat less than 7 ounces of dairy per day (7 1/4 ounces for men)?
7 ounces is by weight and is about a cup of yogurt or a glass of milk
Score:
1 point for less than 7 ounces female / 7 1/4 ounces male
0 point for more than 7 ounces female / 7 1/4 ounces male
5. Do you eat more than 9 ounces of cereals or grains per day (10 1/2 ounces for men)?
2 ounces is about…
1 cup bite size shredded wheat
two slices of whole wheat bread (1 ounce/slice)
1/4 cup of uncooked brown rice
1/2 cup dry whole wheat pasta
1/3 cup uncooked quinoa
Score:
1 point for more than 9 ounces female / 10 1/2 ounces male
0 points for less than 9 ounces female / 10 1/2 ounces male
6. Do you eat more than 3/4 ounces of fish per day (1 ounces for men)?
This is not very much, but the research looked at averages: that’s why it seems to be so little. This really means about two or more 4 ounce servings per week.
Score:
1 point for more than 3/4 ounces female / 1 ounce per day male
0 point for less than 3/4 ounces female / 1 ounce per day male
7. Do you eat less than 3 1/4 ounces of meat per day (4 ounces for men)?
Most people think that a serving of meat is much larger than it should be. Four ounces of beef, chicken, pork, or lamb is about the size of a deck of cards.
Score:
1 point for less than 3 1/4 ounces female / 4 ounces male
0 points for more than 3 1/4 ounces female / 4 ounces male
8. Do you drink between 5 and 25 grams of alcohol per day (10 and 50 grams for men)?
25 grams is the equivalent of about one drink:
One twelve ounce beer
One 5 ounce glass of wine
One 1 ounce shot of spirits
Score:
1 point for between 5 and 25 grams female / 10 and 50 grams male
0 point for less than 5 grams female / 10 grams male
Subtract 1 point for more than 25 grams female / 50 grams male
9. The ratio of the type of fat you consume is important. Do you eat more healthy oils? The optimal ratio is 1.6 portions of healthy fat to 1 portion of less healthy.
Examples of healthy fats:
Olive oil
Canola oil
Grapeseed oil
Peanut oil
Soybean oil
Examples of less healthy fats:
Hydrogenated vegetable oil
Stick or hard margarines
Butter
Lard
Vegetable shortening
Score:
1 point for greater than the optimum ratio of greater than 1.6 to 1 for healthy fats:less healthy fats.
0 point for less than the optimum ratio of greater than 1.6 to 1 for healthy fats:less healthy fats.
Conclusion and Score
There is no passing or failing grade for this test, but the higher your score, the better. A perfect Mediterranean style diet would be a score of 9 and if you’re living on snack food and soda, it is likely your score will be closer to zero.
In 1990 the government passed the Nutrition Labeling and Education Act. The rules prior to that were pretty basic, and the only information required was a listing of the ingredients in the package. You had to be a bit of a detective and know a lot about food to be able to understand what you might be eating. The ingredients were listed in order, by weight, from the largest amount to the smallest amount. That meant that consumers were pretty much on our own, and had to guess how much of something might or might not be in any particular food.
For example, if the first three ingredients were tuna, water and salt, you knew only that there was more tuna and water than salt but no idea how much salt there was. Fortunately, it’s a bit easier now, but reading a food label can be a bit of a challenge because one is faced with more than one number.
For sodium, the Nutrition Facts label is required to list the number of milligrams of sodium per serving. For instance, in the Cheeseburger Macaroni Hamburger Helper the sodium per serving is listed as 760 milligrams (mg). To make it a bit easier the regulations also require that the percent of daily recommendations (RDA) is listed as well. In the case of the Hamburger Helper, the single serving is 32% of the RDA for a day. (The percentages listed on packages are based on a RDA of 2,400 mg per day.)
2,400 mg is a much lower sodium intake than most of us are eating, with the average American consuming between 4,000 mg and 6,000 mg per day. Some estimates place that much higher – in the 10,000 mg per day range for western diets (that’s ten GRAMS of sodium – close to 5 teaspoons of salt).
As with this previous article on reading food labels, the serving size is critical. Most companies that manufacture food such as Hamburger Helper underestimate the portion size dramatically. In truth, a box of Hamburger Helper is only two servings of about 2 to 2 1/2 cups, since no one actually eats only 1 cup for dinner. That means that you have to at least double both the number of milligrams of sodium and the percentage of RDA.
The percentage values of sodium are helpful, but it is best to use them only as a guideline. The key numbers are those that show the amount of sodium in milligrams.
We have much better research on this now and it turns out that the guideline of 2,400 mg is a good target. For those simply trying to eat healthier the American Heart Association recommends 2,300 mg per day (this is about the amount in a teaspoon of salt). Most physicians have their patients with conditions such as Congestive Heart Failure (CHF) and hypertension eat less, however, with a target of 1,500 mg.
I have found with informal testing of recipes that keeping the sodium levels above 300 mg for a main course dish is about the level that most people find “salty enough.”
The best way to approach this is to divide your day into meals with targets at breakfast and lunch under 500 mg sodium and dinner under 1,000 mg total. Look at the Nutrition Facts on any package of food and add the total milligrams of sodium for the foods that you are eating and add up how much sodium is in each meal for the day.
It is better to simply avoid foods like Hamburger Helper and other prepared, boxed, highly processed foods. By choosing recipes from the Web site and other sources that have the Nutrition Facts listed, have reasonable portion sizes and are delicious it means you will be cooking for yourself and, in the end, that is the best way to control your sodium intake.
We eat too much salt. It might be hard to believe, but the average person eats over 6,000 milligrams (mg) of sodium every day. That works out to about 2 1/2 teaspoons of salt, which is about 2 1/2 times the recommended amount of 2,400 mg per day.
If you are used to eating a lot of salt, we do have great evidence that your tastebuds can learn to do without all that sodium. A great study placed a group of people on a sodium restricted diet for five months (Am J Clin Nutr 1982;36:1134-44). Their subjective response to the saltiness of salt in solutions, soups and crackers were measured before and while they were following the diet. The same measurements were made in a control group that didn’t change their diet. In the group that lowered their salt intake, the perceived intensity of salt in crackers increased over the five month period. The amount of salt needed for “maximum pleasantness” of taste fell in the study group but not in the control group.
This is a profound problem for us. Research estimates that reducing salt intake could save 150,000 lives each year. That’s a lot of our friends, family and co-workers.
Take your time making the change to lowering salt in your diet. Here’s how:
Step One
Keep in mind that the 2,400 mg per day recommendation works out to just about 1 teaspoon salt, total. Measure your salt when you do cook. It’s easy and a simple step to being healthier.
Step Two
Frozen or packaged meals, fast food and eating on the run has become too much a part of our lives. The key is to begin slowly by making fresh meals at least a couple of times a week. Each week plan more fresh meals (leftovers work great here also).
Step Three
Stop eating processed foods. Don’t make your Macaroni and Cheese out of a box – cook it fresh. Cooking food from scratch takes a bit more time, but it tastes so much better and is so much better for you. Most importantly, you have direct control of the amount of sodium in your food.
Step Four
When you do eat processed foods, pay attention to the salt. The sodium content is the one item on the Nutrition Facts label that isn’t confusing. Your goal should be less than about 2,400 mg per day.
This is one of the simplest ways to make a major change in your health. Take your time and make changes gradually. Your taste buds will adjust to eating less salty foods and you’ll be so much healthier for it.
