The Harvard Med

Review From User :

One of the best nutrition books I've read. It's the perfect blend of factual nutrition science, study results, explanations of bodily processes, and practical food recommendations. I like to know the science behind the nutritional recommendations, and this book draws on over 40 years of research conducted at Harvard and elsewhere.

The author, Walter Willett, is chairman of the Department of Nutrition at the Harvard School of Public Health, and a professor of medicine at the Harvard Medical School. The diet he advocates uses the Mediterranean diet as a foundation, because it's been shown to reduce heart disease and cancer. He enhances the Mediterranean diet by incorporating decades of nutritional research, resulting in what he calls "a science-based, multicultural approach to healthy eating."

Willett describes the strengths and weaknesses of several popular diets, including low-fat, low-carb, and low-glycemic diets. At the end, he includes recipes with detailed nutritional info.

I was familiar with most of the nutritional advice, but there were a couple surprises. Carbs are a large part of the diet, as long as they're whole grains, not refined. I was most surprised by his stance on dairy, which he says is not only unnecessary in a healthy diet, but potentially dangerous. He gives a very interesting explanation of the role of calcium in the diet, and advice for avoiding osteoporosis. This has motivated me to do more research into dairy.

The Harvard School of Public Health's Nutrition Source has a lot of this book's content online.

Notes
Nutritional strategy
Maintain a stable, healthy weight.
Replace saturated and trans fat with unsaturated fats.
Eat whole-grain carbohydrates instead of refined grain carbs.
Choose healthier sources of protein by eating nuts, beans, chicken, and fish instead of red meat.
Eat plenty of vegetables and fruit.
Use alcohol in moderation.
Take a daily multivitamin for insurance.

Healthy Eating Pyramid
Daily exercise and weight control
Vegetables: in abundance
Fruits: 2-3 times/day
Plant oils (olive, canola, soy, corn, sunflower, peanut, other vegetable oils)
Whole grain foods: at most meals
Nuts, legumes: 1-3 times/day
Fish, poultry, eggs: 0-2 times/day
Dairy or calcium supplement: 1-2 times/day
Red meat, butter, white rice, white bread, white pasta, potatoes, soda, sweets: sparingly
Multivitamin (for most people)
Alcohol in moderation (if appropriate)

Introduction
There's little evidence that getting high amounts of calcium prevents broken bones in old age.

Dairy may increase risk of prostate cancer, ovarian cancer.

Asian, Latin, and vegetarian pyramids promoted by Oldways Preservation and Exchange Trust are also good guides to healthy eating.

It's fine to get >30% of calories from fat, if most is unsaturated.

1 drink/day for women and 1-2 drinks/day for men significantly reduces risk of heart attack, heart disease, clot-caused stroke.

If you don't drink alcohol, don't feel compelled to start. You can get similar benefits from physical activity and healthy eating.

Take a daily multivitamin for "insurance": to fill in nutritional holes.

What Can You Believe About Diet
Biggest determinants of future health: whether you smoke, and your weight.

Healthy Weight
You shouldn't gain weight after your early 20s; weight gain isn't inevitable or healthy.

In a normal diet, the body converts fat, carbs, and protein to fat at the same rate. In terms of conversion to fat, the calories are equal.

High-protein, low-carb diets haven't had long-term studies. High-protein diets can pull calcium out of bones. These diets are high in saturated fat and cholesterol, which can cause heart disease. They could also cause kidney damage in some people.

Exercise at least 30 minutes daily. Brisk walking gives many of the same benefits as vigorous exercise.

Surprising News About Fat
After controlling weight, next most important thing is eating good fats and avoiding bad ones.

Get enough Omega 3
Sources: fish (eat twice a week), walnuts, flaxseeds, canola or soybean oil.
Fish with low mercury contamination: salmon, pollock, catfish, shrimp, light tuna (not albacore).
If you don't eat enough fish, take a fish oil supplement with 600 - 800 mg of EPA and DHA.

Reduce saturated and trans fats, and increase mono- and polyunsaturated fats.

Monounsaturated fat: olive, peanut, & canola oils; avocados; most nuts.

Polyunsaturated fat: vegetable oils (corn, soybean); seeds; whole grains; fatty fish (salmon, tuna); legumes (soybeans, soy products).

Up to 1 egg/day doesn't increase risk of heart disease or stroke.

Replace butter and margarine with olive oil or another liquid vegetable oil (or a margarine low in saturated fat, high in unsaturated fat, and trans fat-free).

Limit full-fat dairy and red meat to reduce saturated fat.

Carbohydrates for Better and Worse
Flour has a higher glycemic index than intact or coarsely ground grains, because of its greater surface area and has had fibrous outer coat removed. Glycemic load of most commercial whole-wheat bread is only slightly lower than white bread, because it's made from fine flour. Bread from coarsely-ground whole grains is better.

Regular oatmeal made of smashed oat grains has a higher glycemic index than intact or sliced oats (steel-cut).

Glycemic load (amount of carbs in food x glycemic index) better reflects a food's effect on body than amount of carbs or glycemic index alone.

Choose Healthier Sources of Protein
Eat more fish, chicken, beans, nuts, and less red meat, dairy.

Aim to eat a minimum of 8 g of protein per 20 lbs of body weight, per day.

Frying and grilling meat, poultry, fish to well-done may increase cancer risk, but it's not clear if this is significant enough to worry about.

Limit soy to a 2-4 servings/week.

Eat Plenty of Fruits and Vegetables
Aim for 9 servings/day.

Eat for variety and color. On most days, try to eat at least one serving of the following:
Dark green, leafy vegetables
Yellow or orange fruits and vegetables
Red fruits and vegetables
Legumes (beans) and peas
Citrus fruits

Cook tomatoes to get more lycopene.

Eat several servings of fresh, uncooked vegetables each week, because cooking damages some phytochemicals.

Frozen fruit and vegetables can be as good as fresh. Canned are OK if they're low in sugar and salt.

You Are What You Drink
Thirst isn't a good guide of need to hydrate. Drink at least one glass with each meal, and one between meals.

Sugar substitutes (saccharine, aspartame, acesulfame-K, sucralose) probably aren't hazardous.

Don't drink milk in large amounts.

Coffee has some benefits and no major health hazards. Tea has no major benefits or hazards.

Calcium: No Emergency
There's no evidence that increasing milk intake protects you from breaking bones later in life.

Low-fat and skim milk are better than whole.

Best way to maintain strong bones is combination of weight-bearing exercises (like brisk walking) and muscle-strengthening exercises.


Extra vitamin D may prevent bone loss. Easiest way to get is standard multivitamin.

Women in middle age and beyond should get 500 - 1,000 mg of calcium per day. Best way is through calcium supplements, though low-fat dairy is an option.

For bone health and to prevent osteoporosis:
Exercise and stay active.
Get vitamin K by eating at least one serving of green leafy vegetables daily.
Take 800-1000 IU of vitamin D daily.

Take a Multivitamin for Insurance
Calcium supplements are cheaper than dairy. Consider chewable calcium-based antacids such as Tums.

A standard, store-brand, RDA-level multivitamin is fine. It's unlikely to cause harm.

Summary
Mediterranean diet is "an excellent place to start" but don't feel limited to it; include healthy foods from other cultures.

Recipes and Menus
Most Americans, even vegetarians, eat more protein than necessary.


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