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What is a healthy diet?
by Dr Rowena Nicholson MBBS MRCGP DRCOG DipPCouns DipNSpH DipTHY&R BSEM member
Most of us want to eat a healthy diet, but it can be difficult to decide on what exactly this is. There is so much information out there, and there have been many different fads and fashions. Although I believe that there is no ‘one size fits all’ healthy diet, the modern Western convenience food diet is certainly very harmful, and what we eat has a huge impact on both our current and future health. What constitutes a healthy diet for patients with specific problems or needs can be very different, so we advise our clients according to their individual needs. However, this article gives an overview of some of the important considerations.
What did we evolve to eat?
The modern diet in the UK is very heavy on processed wheat and other cereals, dairy, sugar/ high glycaemic index foods, saturated fats and many additives and chemicals. This has led many health and allergy experts to look to the Stone Age diet as a guide to what we should be eating from an evolutionary point of view. Although the Stone Age diet was not in historical reality a single diet, the general principles are that it is considered to have contained vegetables/salads, roots, seeds, nuts, fruits, meat, fish and possibly small amounts of wild grasses/cereals. Dairy only became a significant feature in the diet about 5,000 years ago (very recent in our history) and there is much concern about the high levels of dairy currently consumed in the Western diet. Milk is, after all, the perfect food - for a baby cow. Dairy is one of the commonest food allergies/intolerances, and it is thought that about 70% of the world population lacks the appropriate enzyme to properly digest milk sugars (lactose intolerance). Milk contains insulin like growth factors, which cause cells to increase in size and proliferate, leading some health experts to link it to the rapidly increasing rates of breast and prostate cancer in the Western world. In addition dairy products contain high levels of saturated fat, and patients with conditions involving inflammation may find an improvement in their symptoms on omitting dairy products. Some people worry about their calcium intake, as we have been drilled to associate calcium with dairy foods. However, calcium can be found in fortified soya and other ‘milks’, tofu, leafy green vegetables, and dried fruit. In fact, it is now thought that vitamin D and magnesium are more important than calcium for bone health.
Sugar: Number one health enemy?
Some health experts now consider that sugar is on a par, or may even surpass, smoking in its detrimental effect on human health. Sugar is a very recent addition to our diet, and we haven’t evolved to deal with it. Rates of diabetes and obesity have been soaring, and it has been predicted than within 20 years 50% of the population will be diabetic. As a result, it is expected that life expectancies will fall, as diabetes can lead to heart disease, circulation problems, kidney failure and blindness. Epidemiological studies also suggest that cancer rates and sugar consumption are linked, and a low sugar intake forms the basis of most anti-cancer diets.
The Glycaemic Index (GI) of a food tells us how much that food affects our blood sugar level. Low GI foods are ones that release their sugars modestly and slowly; these are the carbohydrates which we should be including abundantly in our diet. High GI foods are those that cause a sudden sharp rise in our blood sugar level, followed by a dramatic fall, and possibly hypoglycaemia. These are the foods that we need to eat infrequently or in small portions.
Low GI foods include: most fruits and vegetables, pulses, quinoa, buckwheat, nuts and seeds, dried apricots, fructose. (And incidentally dark chocolate with a minimum of 70% cocoa solids has a low GI!).
Medium GI foods include: sweet potatoes, mango, plain salted crisps and brown rice.
High GI foods include: Anything containing sugar (cakes, biscuits, sweets, most chocolate bars), melon, dates, dried figs, raisins, baked, mashed or peeled potatoes, chips, parsnips, pumpkins, swede, cooked carrots and beetroot, most breads and breakfast cereals, popcorn, sweet corn/maize, polenta, millet, white rice, white flours, couscous, gnocchi, most pasta, fruit juices, alcohol, any other sweet drinks, rice cakes.
Obviously there are some otherwise healthy vegetables in the high GI group. Having a lower GI diet does not mean eliminating these foods, but it is sensible to base your diet on lower GI vegetables/fruits/pulses/nuts/seeds and then to have small amounts of higher GI foods such as grains or the higher GI vegetables. Many people feel much better on a low GI diet, and it helps to even out sugar levels as well as reducing your risk of diabetes. Those who are over weight usually loose weight on a lower GI diet. The GI of different foods can be found on www.glycemicindex.com. However, it is not necessary to become obsessive about the glycaemic index if you take the broad approach of basing your diet on vegetables, fruits, pulses, seeds and nuts, and enjoying the rest in moderation. The evening meal is a good time to enjoy your complex carbohydrates, as they enhance sleep, and can help eliminate middle of the night wakening due to hypoglycaemia. We do need carbohydrates, but of the right sort and amount. It all comes down to balance. Many people do find it difficult to reduce their sugar intake; we are, in effect, addicted to our high sugar diets. However, most people find that after a few weeks they feel much better, and if they then taste sugary foods or sweets, can find them too sweet.
A word about fats
We need fats in our diet, and essential fatty acids are those fats that we need, but cannot synthesis ourselves. Some vitamins are only soluble in fat, and very low fat diets can be very unhealthy indeed. Many patients who have been advised to follow a low cholesterol diet also end up cutting out healthy fats too; this can result in an elevated homocysteine level, itself a cardiac risk factor. The modern diet usually contains too much saturated fat, which is detrimental to our health. We also usually consume more omega 6 and less omega 3 fats than is beneficial, and this is even more pronounced in vegetarians. You should therefore try to include either fish oils, or flax oil (the latter should not be heated) in your diet. Other healthy fats include: olive oil, avocado oil, nuts, nut oils, flaxseeds, sunflower and pumpkin seeds, nut spreads.
What about vegetarians?
As a vegetarian (near vegan) myself, I am convinced that it is perfectly possible to have a healthy low-GI vegetarian diet which excludes dairy. However, care does need to be taken to ensure that nutritional needs are met. Some vegetarians replace meat and fish with a high dairy and high GI carbohydrate diet, which is detrimental to health. However, the vegetarian diet, well planned, has many health advantages over a meat based diet, not least because many toxins and pollutants accumulate through the food chain in meat and fish. Many studies have found lower rates of bowel cancer and other major health problems in vegetarians. Make sure that you experiment with a wide range of plant foods. Ensure a good protein intake with a range of grains, nuts, seeds and pulses. Meat sources of protein are complete in themselves, but most vegetarian protein sources need to be combined in order to cover all the essential amino acids, for example grains or nuts with pulses. Quinoa, amaranth, buckwheat, tofu, tempeh, lentils, beans and peas are all good sources of protein. Those following a near vegan diet also need to supplement with vitamin B12, as there is no reliable vegan food source. A sublingual preparation is better absorbed than an oral one, and fortified foods are also available. It is also worth including seaweeds in your diet to provide iodine. Given the wide range of foods produced from soya, vegetarians should also take care not to over do soya; one or two portions a day are more than enough. If you are having tofu and kefir made with soya, look for a milk which is non soya and non dairy (e.g. quinoa milk, rice milk, sedge milk etc.), and consider a non soya margarine, or even better, use an oil instead.
Eat a wide range of foods
A healthy diet needs to include a wide range of foods. It is no coincidence that the most common allergies or intolerances are the most common foods in our diets. In the diet which we recommend to many of our patients, the most common UK allergens are excluded: dairy, wheat, maize, and oats. However, if you are healthy and have no food sensitivities/allergies, you may wish to include small quantities of these foods in your diet, but do try to choose the unprocessed/wholemeal versions of these. There is some concern about the lectins (toxins) in modern wheat, and for this reason you may wish to choose older varieties such as spelt or kamut. If you have a particular health problem, we will advise you on a diet to suit you; how strictly you need to follow the recommended diet will depend on the severity/importance of your health issue. For most people however, we advocate a balanced, relaxed, approach; i.e. follow the guidelines most of the time, but do not be obsessive. Remember the old saying: a little of what you fancy does you good! If you are eating out, relax your guidelines. If you fancy the odd glass of wine or some good dark chocolate, or even a dessert, go ahead. (In fact many recipe books have recipes for low GI or healthy non sugar desserts). Small amounts of a wide range of foods reduce the risk of developing allergies, and very restricted diets may be detrimental nutritionally. Go for lots of different colours of vegetables to ensure your antioxidant intake, and try out new things. We are all guilty of getting stuck in a rut, so treat your self to a new cookery book now and again. You may also need to be taking some nutritional supplements. Please see our ‘Should you be Supplementing’ article for more information.
A final word
Above all, enjoy your food. Consider growing your own, or find a local box scheme or farm shop to help you include seasonable vegetables and reduce food miles. Try to source organic and local foods as much as you can. Finding a good health food shop assists greatly, though these days most things can be bought online. Change can take time and effort at first, but once you have worked out a range of easy menus, you will find that such a diet is no more effort than the one you follow now.