The Last Conversation You’ll Need to Have on Eating Right: The Follow-ups

By

The stated goal of our piece on healthy eating was to cut through all the noise and help everyone see how simple it is to eat well — even though it’s in the interests of those who market most of our food to make it confusing.

At the beginning and end of the day, the basic rules of good eating are few and easy to remember (if not always easy to follow). The minutiae, of course, are endless, and there’s no way to address every single aspect of eating well. With that, we’re answering some of the flood of follow-up questions that the first piece stimulated.

I promise I took the advice in your last story to heart, and I understand that most Americans would benefit from eating less meat, but “meat” feels broad. Does chicken count? What about outlier sources of protein, like squab or maybe goat?
Meat of any kind should be a proportionally small part of an ideal diet. The ethical concerns about eating animals certainly pertain to all animals. And the environmental impact of raising meat as food — especially industrially, as almost all meat is — is way higher than that of raising plants. Also, whenever meat is part of the diet, it means that plants make up less as a percentage of the total.

It is, of course, worth noting that some kinds of meat are definitely better than others. The meat of wild game — the kind of meat that is arguably a “native” part of human diets — is low in total fat, low in saturated fat, and a source of omega-3 fat. The meat of contained, domestic, grain-fed cattle is high in total fat, high in saturated fat, and devoid of omega-3. Furthermore, we’ve all read the horror stories about factory-farmed animals; they’re true, and they produce meat that is best avoided. In general, we suggest looking for meat that gets as close as possible to wild game, but we can also say that from ethical, environmental, and dietary perspectives, less meat, of any kind, is better than more.

So does that mean there really is a difference between grass-fed beef and grain-fed beef? Chefs always talk about how great their grass-fed beef is.
First of all: Forget chefs; talk to farmers. They’re the ones who raise it. It’s all still meat, of course, so the issues mentioned above are relevant, but there truly is a compositional difference between the flesh of cattle free to roam and graze on grass, and those confined and fed grains. True pasture-raised, grass-fed beef — and not all beefs called “grass-fed” meet those requirements, by the way — is leaner (lower in total fat) and actually contains some omega-3 fat, which the cattle get from the omega-3 found in grasses and other plants at low levels. If you are going to eat beef, real grass-fed beef is a better choice. We don’t have any clear evidence of differential health effects in people over time, but it just makes good sense.

I’d also like a little more clarity on dairy: organic milk versus milk from grass-fed cows. Hard cheese versus soft. Pasteurized versus raw, etc. What should I really look for when I shop for dairy?
The debates about dairy — including whether humans should consume it at all — go in many directions, and it takes a lot of verbiage to do them justice. Let’s just say that dairy should make up, at most, a modest amount of your total diet. It’s not a predominant source of calories in any of the world’s best diets, and is not a key feature of the Mediterranean diet linked with good health outcomes (although it is a modest component among many variants of the traditional Mediterranean diet).

Most of what’s true for meat is true for dairy: You want dairy from animals fed a diet of grasses and other plants, and given the freedom to roam, graze, and exercise normally. They should be raised “organically” whenever possible, and thus free from exposure to antibiotics and hormone treatments. So, local sources, grass-fed, pastured, and organic would be ideal.

As for hard cheese versus soft, the primary difference is moisture. Hard cheeses are aged longer, and lose more of their initial moisture content. We are not aware of any systematic nutrition differences based on texture.

Okay, let me phrase it another way: How much cheese is too much? Is that possible? I love cheese!
As Paracelsus famously said, the dose makes the poison. Too much of just about anything is possible. As for how much is too much, we have no idea, but here’s a more informative answer: Let’s say you eat the prototypical 2,000 calories per day. The upper recommended intake for saturated fat is 10 percent of calories, and without getting into all of those details here, we think that’s reasonable. An ounce of Parmesan cheese has a little over 4 grams of, or about 36 to 40 calories from, saturated fat. So, a total daily intake of 5.5 ounces of Parmesan cheese, assuming absolutely no other saturated fat in the diet, would reach that 10 percent limit, about 200 calories in this case. By the way, that’s quite a bit of Parm, but cheese in general — if you eat it at all — should be both “good” cheese (made traditionally) and a treat, not a staple.

So, I am still not totally clear on the gut-health thing, except that yogurt helps. Are there gut-healthy things I can eat that aren’t yogurt? Yogurt is not great on my skin.
Fermented foods containing probiotics include kefir, kombucha, miso, tempeh, sauerkraut, buttermilk, pickles (provided they’re fermented), natto, and some cheeses. You can, of course, also get probiotics in the form of supplements.

If there’s one thing that stuck with me after reading the first story, it’s that beans and grains are very good. What about rice? Is there a difference in varieties? Should I stick to brown rice? Is white rice okay?
Brown rice is the whole-grain version of white rice, and is higher in fiber, vitamins, and minerals. Rice, like all grains, loses much if not most of its nutritional quality when the hull is stripped away, converting it from whole grain to refined. There are many varieties of rice, and all provide better nutrition — including a lower glycemic load — in their whole-grain state.

Compared to other grains, rice tends to be relatively low in both fiber and total protein. Because rice is grown in wet paddies, it soaks up a lot of ground water, and with it, some arsenic. Although there is no clear evidence of harm to people from the arsenic in rice, it is nonetheless noteworthy.

I guess I should cut back on the sushi. What about breakfast? I just can’t get into it. I’ve tried! I even made overnight oats once. Is breakfast really as important as people say it is?
No. The importance of eating the minute your feet hit the ground in the morning is folklore. Studies on the timing of breakfast are few, and show mixed results. What it all seems to come down to is hunger. If you’re hungry, and want breakfast but don’t have it, the effects on alertness, concentration, productivity, and such tend to be bad. That’s no great surprise. On the other hand, if you don’t eat breakfast until 10 a.m. or 11 a.m. or even noon because you aren’t hungry until then, there’s no consistent evidence of any kind of harm.

Why do people keep telling me to eat chia seeds?
We have no idea. Are they people you know, or strangers? Although, while chia seeds lack any magical properties, they are highly nutritious: They are a concentrated source of unsaturated fat in general, and omega-3 fat in particular; a rich source of fiber; a good source of calcium; and a source of protein as well.

What if I just drink a smoothie in the morning?
Smoothies can be quick, convenient breakfasts, but the nutritional value all depends on what you put in the blender. Even when made of the best foods — fruits, vegetables, nuts — a smoothie is less good than eating those foods. For one thing, blenderizing foods reduces the time it takes to eat them, and can lead to more total calorie intake and a higher glycemic response. But if a smoothie made of good stuff is your alternative to doughnuts or starvation, then it’s a good move.

Why is California forcing companies to add warnings to coffee? I thought it wasn’t bad for me.
It’s not bad for you. The decision in California is the result of one judge’s decision following a lawsuit filed by a small nonprofit. The issues were the trace, but measurable, amount of acrylamide produced by roasting coffee beans at a high temperature; the possibility that acrylamide could be a (but is not established as a known) human carcinogen; and an act in California known as Proposition 65 that requires a warning label on any item that contains one of hundreds of chemicals listed in the 1986 law. The judge was not convinced by the defense that “sound considerations of public health support an alternate risk level for acrylamide in coffee.” But to prove beyond reasonable doubt — to be free of any potential risk — is a standard that’s not actually possible in nutritional epidemiology.

Overall, coffee intake at reasonable doses appears to be good for most people, and actually associated with reduced cancer risk, not more.

Okay, so coffee is safe. That’s great. But should I get into matcha and other green tea? Are there advantages to drinking that instead?
Tea has more antioxidants and less caffeine, which might be good or bad, depending on why you drink coffee in the first place. Green tea, which is made from the unfermented leaves of the tea plant, is an especially good source of a bioflavonoid antioxidant called EGCG. White tea, by the way, is made from the leaf buds before they unfurl, and is an even better antioxidant source, but this is all probably quite trivial.

There is a general association between green-tea intake and diverse good outcomes at the population level, much as there is for coffee. But there is no decisive proof of cause and effect, since — as we pointed out in the first story — it is hard to isolate the effects of any one food from the general effects of overall diet and lifestyle patterns.

Okay, last coffee question: What’s up with turmeric? Why is it in everything? I saw it in a latte.
Turmeric contains a nutrient compound called curcumin that has well-documented anti-inflammatory properties, but these, of course, are the same as they ever were. Turmeric is suddenly in “everything” because we always seem to need a short list of nutrient or ingredient silver bullets. We shuffle them all periodically to keep ourselves entertained, and so people can sell us stuff.

What’s the deal on natural fruit sugars versus added sugars? After watching What the Health, I’m a bit skeptical of the American Heart Association’s suggestions to limit added sugars to under 25 grams a day and fruits to just two cups per day. Thoughts?
Added sugars really are the concern. There are various recommendations from authorities such as the World Health Organization and the American Heart Association, but the common standard is roughly 10 percent of total calories. In a 2,000-calorie diet, that would be 200 calories, maximum, from added sugars, or a total of 50 grams. By way of comparison, a 12-ounce Coke has 39 grams, or almost 80 percent of that.

The naturally occurring sugar in whole fruit is not a concern. In fact, studies show that eating more whole fruit protects against both obesity and diabetes — the very goals served by reducing sugar intake. Sugar occurs naturally in dairy as well (lactose), and at low levels in vegetables.

As for What the Health, we think it got some things right, but also got some things wrong — and played fast and loose with the presentation of data.

I like something sweet, and don’t always want to just eat fruit. Is there something I can grab instead that will be satisfying and also not make me feel guilty? I’m really asking because Halo Top seems pretty good — only like 300 calories in an entire pint! My friend eats them for dinner and she looks great!
We’ve already railed against the overdose of sugar in most American diets. If you get rid of those sources — soda; over-sugared breakfast cereal; and added sugars in foods that should have none, from pasta sauces to salad dressings to crackers — and choose “cleaner” alternative brands in all of those categories, you will have left room in your healthy diet for some of the sweet stuff where it confers the greatest pleasure: dessert.

Into that bargain, you will have also gone through taste-bud rehab and likely come to prefer your desserts less sweet. You will, in other words, have put sugar in its place, and left a suitable place in your own diet for just a bit of sugar.

That’s the first key step. Then, choose wisely. Dark chocolate — 60 percent cocoa or higher — is generally an excellent choice, as you have likely heard. Or if you are into making your own desserts, that’s a great option.

What about these Complete Cookies? They don’t seem so bad. Can I eat one of those instead?
Vegan junk food is still junk food. Of course you can eat one, but don’t go thinking it’s “better” for you than an Oreo.

On packaged foods, why am I always told that short ingredients lists are indicative of healthfulness? The advice seems so arbitrary. Some simple things are terrible; some things with complicated names are not terrible. Why do people keep pushing this advice?
We feel rather the opposite about this, and it is advice we have used. Consider that all of the truly best foods — broccoli, spinach, blueberries, walnuts, avocados, kale, and so on — have an ingredient list just one word long.

With processed foods, it is generally true that the longer the ingredients list, the more manufacturing mischief, such as additions of texturizers, flavorants, colorants, sweeteners, emulsifiers, preservatives, and so on.

You are right that there are some quite dubious foods with very short ingredients lists, many sodas among them, but still, these are exceptions to a general rule that works quite well when applied with a bit of common sense.

I am a LaCroix superfan. It’s seltzer, which I know is more or less fine, but “INNOCENT!” is also printed right on the label, which feels Trump-esque and makes me think maybe it’s not so innocent? Should I worry about whatever it is they use to flavor zero-calorie drinks?
Seltzers made with carbonated water and natural flavors extracted from the named fruits, with no sweeteners and no calories, are indeed innocent. Enjoy!

Are sprouted grains, and products made with sprouted grains, really better for us?
Probably yes, just based on the concentration of nutrients. For example, B vitamin concentration tends to increase as grains sprout. But on the other hand, there are a lot of nearly magical properties attributed to sprouted grains — curing cancer among them — and here, we append common counsel: When something seems too good to be true, it almost certainly is. We are aware of no evidence supporting claims of sprouted-grain magic.

I know I shouldn’t care about fad diets, but look, summer is coming up and I need to lose some weight. My friend swears by the Potato Hack — he eats nothing but plain potatoes for a few days and he loses a lot of weight that he says he can keep off. Even he knows it sounds insane, but he says it works! Is it really so bad for me if I just eat potatoes for a few days to get into swimwear shape?
We aren’t surprised that this “works.” Almost any approach to restricting food choice severely — whether eating no meat, or only meat; just grapefruit, or cabbage soup; fasting periodically, or eating only potatoes — will limit calorie intake, and by that means, favor weight loss. In a generally healthy person, eating only potatoes for a few days before returning to a balanced diet is unlikely to do any acute harm.

But we would point out an inconsistency with your friend’s story, at least as it has been related to us. If this weight can, indeed, be kept off, why does he need to reapply this strategy? Count us among the dubious!

That tends to be the problem with all “restrict food choice severely, then normalize” dietary approaches. Unlike just eating well and being active, they do not stand the test of time. Losing weight in the short term isn’t really the hard part, and it isn’t necessarily good for you, either. Focus on long-term weight control, and more importantly, the pursuit of health and vitality. If potatoes help you get there, we are onboard.

What about the Whole30 diet. Everyone loves it, and it seems okay? Whole foods, no added sugar. These sound reasonable! What’s the deal?
We think it is a pretty silly diet, like every other “lose weight fast” diet. The basic approach is to cut out a wide variety of foods to lose weight. To reiterate, that works every time, whichever way you direct the scissors.

But the Whole30 expressly cuts out some of the healthiest foods of all, notably beans, which are also consistently associated with weight control, not weight gain. This makes no sense to us as anything other than a get-thin-quick marketing gimmick. The Whole30 is also like all other “cut out foods” diets in that it then invites you to add foods back. Usually, that invites the weight back, too.

In principle, such diets could be a springboard to permanent diet change, but then, why not just make reasonable, permanent diet changes and cut out the middleman?

I should just assume that your feelings on the Clean 20 are similar, right? I need to look good when I hit the pool in a month, guys!
You assume correctly.

Should I just pretend I live somewhere warm and eat a Blue Zone diet? I’ve read that people in Greece live until they’re, like, 150, and they seem to eat pretty well!
“Warm” doesn’t seem to have much to do with it. There is a Blue Zone in the hills of Sardinia, and it does get quite chilly up there. But your comment about climate really does suggest a bigger issue: the matter of environment, and culture.
A valid criticism we found after our first story was published was our failure to say much about the social determinants of health, and we couldn’t agree more about the importance of that topic. So now that we’ve answered all of your questions (again), let’s talk about those. In the Blue Zones, people don’t get to health by adopting a diet or lifestyle at odds with the prevailing culture. That’s really hard to do. Rather, they get to health because their cultures make healthy choices the default choices. Everyone walks every day. Everyone eats plenty of fruits and vegetables.

There’s no room here for a full discussion of the social and environmental factors influencing health, but we want to note their importance. We make the case that the fundamentals of eating well are clear and simple; we do not make the case that they are easy in a country that runs on Dunkin’, where multicolored marshmallows are marketed to 6-year-olds as part of a complete breakfast; and where the farm bill favors monocultures for fattening feed animals over produce for human consumption.

Okay, I get it! Whole foods, cooked simply, and lots of grains are good for me. But that can also be a lot of work! Are there any really convenient options — like delivery or microwave meals — that are actually good for me and won’t leave me broke?
This is a great question that raises a number of important issues. Superficially, yes, microwave ovens are fine, and they can make a hot meal more convenient. There are some very interesting innovations in the world of “ovens,” too, that will likely take quick, convenient home food prep to whole new places. And delivery is, well, convenient. But there’s also a matter of priorities here.

Cooking is the most traditional, honored, delicious, and healthy way to eat. If more of us spent time picking our own ingredients, the best we can afford, and cooked them ourselves, we’d be far better off.

Mark Bittman is the author of How to Cook Everything Vegetarian and How to Grill Everything.

David L. Katz, MD, MPH, FACPM, FACP, FACLM, is the founding director of Yale University’s Yale-Griffin Prevention Research Center, Immediate Past-President of the American College of Lifestyle Medicine, and founder/president of the True Health Initiative. He is the author of the forthcoming book The Truth About Food.

The Last Conversation on Eating Right: The Follow-ups