Summary of Foods To Embrace

• Whole grains: Brown rice, pasta, breads, and cereals should be staples. Seek out different varieties of grain such as barley, bulgar, wheat berries, oat groats, quinoa (pronounced "keen-wah"), etc. Cook up a large batch and enjoy it during the week, at work or for dinner.
• Vegetables: Try to include a cruciferous vegetable every day. Aim to have three or four vegetables a day. Get in the habit of including two types for dinner.
• Fruits: The goal is to enjoy 3-4 servings per day. Try to include a fruit with every meal. Calcium fortified orange juice is an easy choice at breakfast (there is 400 mg of calcium in one glass, equal to milk).
• Legumes: Use a variety of cooked dried beans as simple meat substitutes. Mix them with the grains you’ve stored up for the week. Add them to soups, stews, pasta, or salads. Begin to use tofu and other soy foods daily. Tofu is great with any food – it takes the taste of whatever you match with it. Enjoy fortified soymilk once or twice per day, and make one a soy product.
• Nuts and seeds: Almonds lower cholesterol and walnuts are a rich source of omega-3 fatty acids.  Nuts contain monounsaturated fat which is healthful.  They make a great "non-carbohydrate" snack.  Numerous studies have confirmed that a diet containing nuts and seeds reduces the risk of cardiovascular disease.
• Omega-3 fatty acid sources: Eat green leafy vegetables, soy foods, wheat germ, walnuts and other nuts/seeds, and an occasional fatty fish (salmon, tuna, etc). Flaxseed oil is so loaded with omega-3 fatty acid that we recommend adding 1-2 teaspoons per day to your food.
• Monounsaturated oils: Olive oil and canola oil are wonderful substitutes for butter, margarine, and the other vegetable oils. Use these oils (though sparingly) with flax oil to make your own salad dressings, and enjoy with potatoes, vegetables, and with breads. You can of course cook with olive oil and canola oil (you should not cook with flax oil).
• No-fat milk and dairy products are fine.  That means use cheese sparingly (buy more flavorable cheeses.

There are many foods that are nourishing, helpful, and protective for our bodies. These are foods that we need to seek out and intentionally include in our diet to achieve optimal health. Sadly these healthful foods are not typically found in fast/convenience meals or when eating out at even "good" restaurants. These foods exist in a plant-centered diet, which is a diet of abundance and hugely delicious variety. Enjoy!

Fiber is made up of long chains of sugar molecules joined by bonds, which our digestive system cannot break down. These polysaccharides originate from plant cell walls and are found in vegetables, fruits, legumes, whole grains, nuts, and seeds. Fiber is found only in foods from the plant kingdom. Animals have bones to support them, and no fiber is found in animal-based foods. There are two commonly mentioned categories of fiber. Soluble fiber (it dissolves and swells in water) such as oats, flax, and psyllium are known to reduce blood cholesterol. The second type of fiber is insoluble fiber (it will not dissolve, but attracts and soaks up water) found in wheat bran, legumes, seeds, and many vegetables. Insoluble fiber is known to relieve constipation and is felt by some to "detoxify" the gut. There are so many sources of fiber to be enjoyed and taken advantage of. Merely sprinkling bran on cereal at breakfast gives us a small increase in one insoluble fiber only, while a healthy diet includes the wide variety of food sources containing fiber. The typical American diet contains 10-18 grams of fiber, while experts recommend 25 to hopefully 40 grams of fiber daily.

There is one important cautionary point to make, however. The healthful diet needs to include whole, "real" grains to contain fiber. Most people make grains a large part of their diet, but they eat primarily refined, processed, white rice, pasta, white potatoes, French fries, and bread. While these refined carbohydrates are not harmful these grains are depleted of fiber and represent empty calories and little else. One shouldn’t make such white-nothingness food the foundation of her/his diet. Whole grains are a rich source of phytochemicals, minerals, and vitamins also. When whole grains are refined and processed we lose the grains bran (fiber) and wheat germ (vitamin E, phytochemicals, and minerals), and are left with only the endosperm (core of the grain) which is essentially only carbohydrate.

The Nurses Health Study and Health Professionals Follow-up Studies are two huge on-going dietary studies, which clearly show the benefits of a high fiber diet. Soluble fiber slows the absorption of carbohydrates (sugar) and helps smoothen out blood sugar control in people with diabetes. (People with diabetes recognize that eating a slice of white bread- or any refined white grain- can shoot their blood sugar up and avoid an insulin reaction). In these studies eating whole grain breakfast cereal even decreased the risk of developing diabetes. Consuming a diet containing soda pop, white bread/rice/pasta, French fries, and potatoes increased the risk. The Nurses Health Study found that women who ate the most intact grains (average 2.5 servings a day versus women eating 1 serving a week) reduced their risk of heart disease by 30 percent. Eating whole grain breakfast cereal, brown rice, and whole grain bread has consistently been found to be protective. While it is known that solule fiber (oat meal, etc) does lower blood cholesterol levels there are clearly other heart benefits not yet understood.  Intact grains plus legumes, fruits and vegetables decreases constipation by keeping the stool soft. Diverticulosis (tiny out-pockets in the colon), diverticulitis (occurring when they become inflamed), and hemorrhoids can be prevented. In areas of the world where high fiber intake is common, the existence of diverticular disease, hemorroids, and fissures is very rare.  Numerous studies have shown that whole grains (containing fiber, phytochemicals, and vitamins) decrease the risk of cancer of the colon, mouth, stomach, gallbladder, and also ovarian cancer.

Typically people eating a higher fiber diet may complain of more frequent soft stools, but that is "the price to be paid" for greatly improved health. We are fortunate in the Minneapolis-St. Paul to have the largest food co-op network in the U.S.A. Diane and I purchase grains from "The Wedge" in Minneapolis. We keep a multitude of grains on hand (those less frequently used stored in the freezer to avoid rancidity); buckwheat groats, quinoa (pronounced keen-wah), wheat berries, barley, brown rice, and bulgar are our staples. Find a health food co-op grocery near you and have fun exploring the many different grains available- it really is a taste adventure.

It is recommended that a person consume five or more servings per day of fiber containing foods (bread, rice, pasta, cereals, and other grains). A serving is considered to be ½ cup of hot cereal, one ounce of dried cereal, or one slice of bread.

Fruits and vegetables are storehouses of key health-promoting components. Besides fiber, a large percent of our phytochemicals are derived through vegetables. Phytochemicals are chemicals within plants, which are meant to protect them from predators. It has been discovered in only the last decade that they also protect us from disease, infections, and cancers. The golden age of nutrition in the early 1900’s refers to the period of time when vitamins and minerals were discovered in plant food. We are now going through an equally exciting time with an explosion of new information regarding phytochemicals, non-nutrients with potent biological activity. There are thousands of phytochemicals and they might very well prove to be the "minerals and vitamins of the 21^st century".

Widely discussed are the phytoestrogens – isoflavones such as genestein (in soy foods), lignans (in flaxseed). These compounds are weak estrogens. They bind to estrogen receptors in the body producing a "weak" effect, thereby blocking stronger estrogens from attaching to the estrogen receptors. This is one theory proposed to explain the far lower incidence of breast cancer seen in Japanese women who consume tofu and other soy foods on a daily basis. This is also the mechanism thought to explain why Japanese women do not experience hot flashes/hot flushes (there isn’t a word in the Japanese language for this symptom of menopause). Cruciferous vegetables (cabbage, brussel sprouts, broccoli, cauliflower, turnips, kale, and bok-choy) contain indoles and isothiocyanates that have also demonstrated anti-cancer potential. Onions and garlic contain allium, legumes contain soponins, and grapes, strawberries, and nuts contain phenolic acids. Umbelliferous vegetables (carrots, parsley, parsnips, and celery) contain flavonoids. Allium, soponins, phenolic acids and flavonoids all show promise to decrease risk of heart disease and cancer.

There are many known and yet unknown phytochemicals and one needs to seek out the whole variety for optimal health. We live in a period where biomedical companies are looking for a "quick fix". There is a continued attempt to isolate a specific phytochemicals, process it into a pill, and hope that it will be the "magic bullet" to be packaged and sold. Betacarotene is an example of a phytochemical, which researchers hoped would be the key in the fight against cancer. However, betacarotene is just one of 600 carotenoids (there are 20 different carotenoids in a single orange) and it has not proven to be the active ingredient. Lycopene, a carotenoid in tomatoes, is as potent an antioxidant as betacarotene, and has recently been shown to decrease the risk of prostate cancer. The take-home message from this is that we need to "eat the foods". No one knows which phytochemicals are disease fighting, nor how they interact with one another. We do know that people consuming 7-10 fruits/vegetable servings a day have one-third of the cancer risk and one-half the heart disease risk as those eating just 1-2 daily.  That is an amazing benefit.  Please don’t wait for researchers to "discover" the magical phytochemical. Eat the foods now.

Patients often tell us that in an effort to lose weight or decrease cholesterol, they might skip breakfast and have a quick sandwich at lunch, reserving their main meal for dinner. This type of "elimination diet" might help to reduce total calorie and fat intake, but clearly it makes a healthful diet (rich in the key components found in fruits and vegetables) impossible. When one hears the word "diet" most people immediately think of "foods to avoid, going without, and hunger." Instead, "diet" should prompt one to "eat healthfully, make sure I’m eating the proper amounts of fruits, vegetables…" Ideally, one needs to include at least one serving of fruit with each meal and it might be as simple as putting fruit on cereal or having orange juice at breakfast. We need to consciously seek out these health-promoting foods. Steinmetz and Potter, authors of a phytochemical review, sum it up best. "Vegetables and fruits contain the anti-carcinogen cocktail to which we are adopted. We abandon it at our peril."

The national recommendation is that people eat seven to ten fruits plus vegetable servings per day. If calorie restriction (weight loss) is an issue, make it a point to eat whole foods. For example, there are far fewer calories in a whole apple than found in dried apples, applesauce, or apple juice. One would have to eat five apples to match the calories (and sugar content, if you are a diabetic) of one glass of juice. Aim for a fruit or vegetable with each meal, and include one with a snack, too. One serving equals one cup of raw vegetables or ½ cup of cooked vegetables, one medium piece of fruit, ½ cup of cooked fruit, or four ounces of juice.

Legumes (another name for beans, peas, and lentils) act as a great meat substitute and offer healthy components which animal foods cannot. Legumes are cholesterol-free, high in protein, high in fiber, and are packed with phytochemicals and calcium. Foods in this group are all the cooked dried beans (the most common are soy beans, split peas, chick peas, pinto, kidney, navy, lima, Great Northern, brown and black turtle beans, and lentils) and all soy products (including tofu, tempeh, textured vegetable protein, and soy milk). Unfortunately, the average person’s acquaintance with legumes begins and ends with canned baked beans. If you don’t already, begin to keep jars of different legumes on hand and look for ways to incorporate them into your diet. If you enjoy variety then get lots of jars – there are eleven thousand different types of legumes! Learning how to conveniently cook legumes is crucial (see "Cooking Tips and Recipe" section). Add beans to pastas, salads, soups, stews, and get in the habit of keeping a pot of a basic bean and grain salad in the refrigerator – simply add a vegetable for a quick meal.

Soybeans are the "king of legumes" which we believe go underused. Soy is an excellent source of protein. We won’t get on a soapbox about the global sustainable benefit of soybeans nor will we "streak naked at the Academy Awards" to make our point, but eating soybeans, tofu, and the multitude of soy products is wonderful for a balanced diet. Most vegetarians don’t miss meat due to so many great soy-based meat look-a-likes. Soy products are loaded with phytoestrogens, which may play a role in reducing osteoporosis, breast cancer, and heart disease risk. Soy clearly lowers blood cholesterol.  Fortified soymilk is a wonderful dairy substitute that is high in calcium, vitamin D, vitamin B12, riboflavin, and a good source of protective fat. Simply try soymilk over your breakfast cereal for a healthful change. By switching from cow’s milk to fortified soymilk you get the same amount of calcium (400 mg per glass) and also receive the above nutrients, plus phytochemicals. That’s taking advantage of every calorie you take in! Of note, if you do not enjoy the taste of soymilk then try rice-soy milk or flavored soymilk. Aim for at least one serving of soy foods daily.

It is recommended that one consume two legume servings daily (one serving equals ½ cup of cooked beans, ½ cup tofu or tempeh, 8 ounces of soymilk, or ½ cup rehydrated textured vegetable protein). Tofu is incredibly versatile. Please check out the recipe section for a few ideas for dinner tonight!

Almost everyone has heard something of the debate over "good fat versus bad fat". In an effort to avoid total and saturated fat, cholesterol, and trans-fatty acids, it sounds at times as if all fats are to be avoided like the plague. This is not true. The reality is that fats are needed to support life. The key is to choose your fats wisely and then incorporate them tastefully into your meal planning. Rather than just obsessing on total fat intake, concentrate on replacing the above mentioned "bad" fats in your diet with "good" fats (composed of monounsaturated and polyunsaturated omega-3 fatty acids). Fatty acids are the building blocks that form the fat we eat. These fatty acids are grouped into three categories: saturated, monounsaturated, and polyunsaturated. This refers to whether the fatty acid carbon atoms are filled with hydrogen atoms, or are less than fully "saturated". Individual fatty acids have profoundly different effects on our health, from either promoting or preventing cancer, heart disease, and inflammatory disorders. We know that fats composed primarily of saturated fatty acids are bad news, but what about the others?

Monounsaturated fats (a fatty acid molecule with a single point that is not "saturated" with hydrogen atoms) are cholesterol neutral and can actually lower LDL ("bad") cholesterol. Examples of monounsaturated fats include olive oil, canola oil, hazelnut oil, avocados, olives, almonds, pecans, pistachios, and macadamia nuts. Olive oil is a great substitute for commonly used, highly saturated fats found in butter and other vegetable oils. It really should be your "workhorse", primarily cooking oil. Do remember that even this "good" oil has fourteen grams of fat per tablespoon. Since fat is calorie dense (nine calories/gram of fat versus four calories/gram of carbohydrate or protein) please use only what you need! Researchers speculate that the higher consumption of monounsaturated fats from olives and olive oil in the Mediterranean diet may part be responsible for the relatively low incidence of coronary artery disease in Italy and Greece – despite the region’s fairly high total dietary fat content. The Mediterranean diet is in stark contrast to the typical American diet relying on saturated fats and trans-fatty acids, which is associated with a much higher incidence of coronary artery disease. In other words, the type and quality of at in the diet does matter.

Of supreme importance, there are two particular fatty acids, which are absolutely essential to life – meaning that our bodies need and cannot manufacture these on their own. These two "essential fatty acids" (EFA) are the omega-3 and the omega-6 fatty acids. Linoleic acid is the parent omega-6 fatty acid and alpha-linolenic acid is the primary omega-3 fatty acid. These two fatty acids are polyunsaturated fats. When absorbed, they are desaturated further in our bodies to form powerful hormones (eicosanoids), which have significant impact on our health. The omega-6 fatty acids are converted to arachidonic acid, which acts to increase blood clotting, promote inflammation, and raise blood pressure. This is an important function under certain circumstances (acute physical stress, trauma, etc). The omega-3 fatty acids are converted to eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). These substances have potent effects in decreasing blood coagulation, inhibiting inflammation, and lowering blood pressure. EPA and DHA are in fact the active substances in fish oil pills that many people take.

Both the omega-3 and the omega-6 fatty acids are essential and need to be in our diet. Because of their effects on the body, under ideal circumstances their intake should be relatively equal in total amount. The two families compete against one another, and optimal function is dependent on a balance of the omega-3 and omega-6 fatty acids. The balance of powerful eicosanoid hormones in your body hinges on your food choices. Our typical American diet unfortunately has become hugely skewed in favor of omega-6 fatty acid intake. While the ratio ideally would be 1:1 or, at most 7:1 of omega-6 to omega-3, in reality our ratio is closer to 20:1! If your diet is high in omega-6 fats for example, your body will produce more pro-inflammatory eicosanoid hormones. Existing research suggests that this imbalance then increases your risk of common allergies, asthma, and many other autoimmune/rheumatologic disorders (systemic lupus, colitis, psoriasis, inflammatory arthritis, etc). High levels of omega-6 fatty acid eicosanoids have been associated with cardiovascular disease, hypertension, obesity, depression, diabetes, and even premature aging. The reverse is found if your diet is rich in omega-3 fatty acid instead. One immediate, tangible benefit women might notice from an improved omega-6 to omega-3 ratio, for instance, is the decrease of menstrual cramps promoted by high levels of arachidonic acid which plays a key role causing monthly inflammation and cramps. Obviously, good nutrition benefits our body and improves quality of life in so many ways!

The Lyon Heart Study, first published in Lancet in 1994 and recently followed up in Circulation (March 1999), loudly demonstrates that dietary fat "quality" can be more crucial than fat "quantity". Compared to "the prudent Western-type diet" this Mediterranean omega-3 rich diet showed a 70 % reduction in all-cause mortality due to a reduction in fatal heart disease. This diet’s primary emphasis was to lower omega-6 consumption and raise omega-3 levels. The really striking health/mortality lowering benefit was achieved despite the fact that individual blood cholesterol levels were not even improved! Keep in mind the "the Lyon Heart diet" achieved a greater reduction in coronary heart mortality than any cholesterol-lowering drug to date. Therefore, there obviously is more to a healthful diet than it’s mere ability to lower cholesterol. Possibly monounsaturated fats (olive oil) are beneficial, but clearly we need to seek out foods rich in omega-3 fatty acids.

Historically, the human diet did contain a much higher proportion of omega-3 to omega-6 fatty acids than today. Our forebears once obtained abundant omega-3 fatty acids from wild plants (such as purslane) and then from fish and lean game that consumed these plants. Historical research suggests that the omega-6 to omega-3 ratio in food consumed was perhaps 4:3. Then, in far too short a time period to permit human genetic adaption our food supply was radically altered. Since the Industrial Revolution refining and hydrogenation have extended the shelf life of our fats and oils, but this process has reduced and damaged the omega-3 fatty acid content of food. Since foods rich in omega-3 fatty acids are highly perishable, they are not sought after as ingredients in commercial foods. Additionally, omega-6 fatty acids are everywhere, commonly found in fried foods, baked goods, convenience foods, margarines, and vegetable oils (safflower, sunflower, cottonseed, and corn oil). In contradistinction, omega-3 fatty acids have grown scarce in the typical diet and we need to aggressively seek them out. Omega-3s are found in flaxseed and flax oil, fatty fish (like salmon, mackerel, tuna, and sardines), canola oil, soy foods, dark green leafy vegetables, wheat germ, and some nuts such as walnuts. These foods are not exactly household staples. Obviously, one would need to understand the omega fatty acid imbalance and intentionally seek out omega-3 fatty acids to correct the problem.

Given this, Diane and I recommend flax as the reliable source of omega-3 fatty acid supplementation (flax is part of the Dean Ornish heart disease "reversal diet" also). Flax is the richest source of omega-3 fatty acids available, which makes it ideal. Fifty-seven percent of its total fat comes from omega-3 fatty acids and, with it, comes soluble fiber and valuable phytochemicals as a bonus. Flax is loaded with omega-3 fatty acids! Unless you dramatically alter the way you eat there is no easier source of omega-3 fatty acids (for instance, canola oil has only a fraction of omega-3’s, and at 14 grams of fat per tablespoon in any oil we should use a concentrated source). By cutting out processed, convenience foods (omega-6 fatty acids) and supplementing the diet with 2 teaspoons of flaxseed oil daily you accomplish two things: First, the production of inflammatory arachidonic acid from omega-6s becomes partially blocked. Second, the omega-3s of flax lead to enhanced levels of blood vessel dilating, clot preventing DHA and EPA. Supplementing the diet even further with DHA and EPA eicosanoids (fish oil capsules) has an obvious added potential benefit. A typically recommended daily amount of flaxseed would be 1-2 teaspoons of oil or 1-2 tablespoons of ground flaxseed daily. We personally have found flaxseed oil to be the most convenient source. Because flaxseed oil is highly unsaturated ("polyunsaturated") it is unstable and goes rancid if exposed to heat, light, or oxygen. Therefore, you should keep it in the refrigerator and add it to food when needed. Buy flax oil in small amounts (it comes in a plastic bottle, meant to block out light). It is much more expensive if purchased as a capsule supplement. You shouldn’t cook with it, but you can add flaxseed oil to many foods. It complements olive oil in salad dressing, drizzle it over steamed vegetables, baked Russet or sweet potatoes, or use it with Italian seasonings to dip your fresh, hot bread into. We use flaxseed oil on foods where one typically would be tempted to use butter. An extra benefit is that the flaxseed oil helps with absorption of phytochemicals from the vegetables themselves.