Eating for LIFE

Eat for life? Eat to improve your chances long and healthy
life? Yes, you can.

At a time when we seem to be overwhelmed by conflicting
diet and health messages, the National Cancer Institute (NCI)
and the National Heart, Lung, and Blood Institute (NHLBI) have
some good news: by making the right food choices, you may
reduce your risk of developing cardiovascular disease and
cancer.

These diseases take the lives of more Americans than all
other illnesses and causes of death combined. Each day, about
three out of every four deaths in the United States will occur
as a result of cardiovascular disease or heart disease (like
heart attacks and strokes) and cancer. This need not be.
Although no diet can ensure you won't get a heart attack,
stroke or cancer, what you eat can affect your health. This has
been shown by research of the National Cancer Institute and the
National Heart, Lung, and Blood Institute (two of this
country's National Institutes of Health), along with the
research of other scientists.

How does a person eat for life? It's easier and more
enjoyable than you might think. The practical ideas in this
booklet show you how to make healthful, tasty, and appetizing
food choices at home and when you're eating out. They are
consistent with the Dietary Guidelines for Americans, published
by the U.S. Department of Agriculture and the U.S. Department
of Health and Human Services. These seven basic guidelines are:

* Eat a variety of foods.

* Maintain desirable weight.

* Avoid too much fat, saturated fat, and cholesterol.

* Eat foods with adequate starch and fiber.

* Avoid too much sugar.

* Avoid too much sodium.

* If you drink alcoholic beverages, do so in moderation.

The first two guidelines form the framework of a good
diet: eat a variety of foods so that you get enough of the
essential nutrients you need, and eat only enough calories to
maintain desirable weight. The next five guidelines describe
special characteristics of a good diet-getting adequate starch
and fiber and avoiding too much fat, sugar, sodium, and
alcohol. Although the guidelines are designed for healthy adult
Americans, these suggestions are considered especially
appropriate for people who may already have some of the risk
factors for chronic diseases. These risk factors include a
family history of obesity, premature heart disease, diabetes,
high blood pressure, or high blood cholesterol levels.

This pamphlet focuses on five guidelines that are
particularly related to the prevention of heart disease and/or
cancer: eat a variety of foods; maintain desirable weight;
avoid too much fat, saturated fat, and cholesterol; eat foods
with adequate starch and fiber; and avoid too much sodium.

Keep in mind that staying healthy requires more than just
good nutrition. Regular exercise, getting enough rest, learning
to cope with stress, and having regular physical checkups are
important ways to help ensure good health. Checkups are
especially important for early detection of cancer and heart
disease. Another important way to reduce your risks of heart
disease and cancer is not to smoke or use tobacco in any form.
Controlling high blood pressure (hypertension) can also greatly
reduce your risk of heart disease and stroke. Remember, three
of the major risk factors for heart disease are largely under
your control. They are smoking, high blood pressure, and high
blood cholesterol.


How Do the Foods We Eat Affect Our Chances of Getting Cancer
and Heart Disease?


There is much still to be learned about the relationship
between the foods we eat and our risk of getting cancer and
heart disease. The NHLBI and NCI are conducting a great deal of
research to find out more about this relationship. There is,
however, a lot that we know now. The relationship of diet to
cancer and the relationship of diet to risk factors for heart
disease are summarized below:


Obesity


* We know that obesity is associated with high blood
pressure, high blood cholesterol, diabetes, heart disease,
and stroke, Extreme obesity has also been linked to
several cancers. This means that if you are obese, losing
weight may reduce your chances of developing these serious
diseases or conditions. If you already suffer from
hypertension and are overweight, weight loss alone can
often lower your blood pressure to normal levels. Because
fat (both saturated and unsaturated fat) provides more
than twice the number of calories provided by equal
weights of carbohydrate or protein, decreasing the fat in
your diet may help you lose weight as well as help reduce
your risk of cancer and heart disease. Today, most
Americans get about 37 percent of their daily calories
from fat. Many experts suggest that fat should be reduced
to 30 percent or less of calories.


Heart Disease


* We know that high blood cholesterol increases your risk of
heart disease, especially as it rises above 200 mg/dl
(milligrams of cholesterol per deciliter of blood). The
evidence is clear that elevated cholesterol in the blood,
resulting in part from the foods we eat and in part from
cholesterol made in the body, contributes to the
development of atherosclerosis, a disorder of arteries
that results in their narrowing and in reduced blood
circulation. This condition can lead to a heart attack or
stroke.



* We know that blood cholesterol levels are greatly
influenced by the amount of saturated fat and cholesterol
found in many of the foods we eat. These raise blood
cholesterol levels. (Of the two, saturated fat seems to be
the major dietary factor which affects blood cholesterol.)
To reduce your blood cholesterol level, it is important to
eat less saturated fat and cholesterol. Saturated fat and
cholesterol are often found together in foods. Saturated
fat in the U.S. diet is provided primarily by animal
products such as the fat in meat, butter, whole milk,
cream, cheese, and ice cream. There are a few vegetable
fats--coconut oil, cocoa butter, palm kernel and palm oils
which are also high in saturated fat. Cholesterol is found
only in animal products eggs, meat, poultry, fish and
dairy products. Plant foods such as vegetables, grains,
cereals, nuts, and seeds do not contain cholesterol. A few
foods are high in cholesterol but relatively low in
fat--for example, egg yolks and liver.

Watch out for items in the grocery store that are labeled
no cholesterol or, contains no animal fat." They may still
contain a large amount of fat or saturated fat. Examples are
peanut butter, solid vegetable shortening, nondairy creamer,
and baked products like cookies, cakes, and crackers. For
people trying to lose blood cholesterol level, these foods
should be chosen less often.

* We know that substituting unsaturated fatty acids (which
are usually liquid and usually come from plant sources)
for saturated fats can help reduce high blood cholesterol.
Safflower, corn, soybean, olive, and canola oils are major
sources of unsaturated fats. The omega-3 fatty acids which
are found in fish and seafood, may have a favorable effect
on blood fat and reduce the risk of heart disease. No one
is sure yet.

* We know that there is an association between too much
sodium in the diet and high blood pressure in some
individuals. Sodium is a mineral that occurs naturally in
some foods and is added to many foods and beverages as
salt or other additives. Most sodium in the American diet
comes from salt. One teaspoon of salt contains about 2
grams of sodium. In countries where people eat only small
amounts of sodium, high blood pressure is rare. We also
know that when some people with high blood pressure
greatly reduce their sodium intake, their blood pressure
will fall. Because Americans generally eat much more
sodium than they need, it is probably best for most people
to reduce the amount of sodium they eat. According to the
National Academy of Sciences, a safe and adequate amount
of sodium in the diet of the average adult is between 1
and 3.3 grams daily.

Some recent studies indicated that the substitution of
monosaturated fats, such as those saturated fats may lower
blood cholesterol.


Cancer


* The National Cancer Institute estimates that about 80
percent of all cancers may be related to smoking, diet,
and the environment.

* The National Cancer Institute estimates that about
one-third of all cancer deaths may be related to the foods
we eat. Studies at the National Cancer Institute suggest
that eating foods high in fiber may reduce risks of
cancers of the colon and rectum. Adult Americans now eat
about 11 grams of fiber daily according to NCI studies.
NCI recommends that Americans increase the daily amount of
fiber they eat to between 20 and 30 grams, with an upper
limit of 35 grams. The NCI also emphasizes the importance
of choosing fiber rich foods, not supplements. Good sources
of fiber are whole grain breads and bran cereals,
vegetables, cooked dry peas and beans, and fruits.

* We know that diets high in fats of all kinds have been
linked to certain cancers, particularly those of the
breast, colon, lining of the uterus, and prostate gland.
Some studies have suggested that fat may act as a cancer
promoter (an agent that speeds up the development of
cancer).

* There is some evidence that diets rich in vitamin A,
vitamin C, and beta-carotene (the plant form of vitamin A)
may help reduce the risk of certain cancers. The evidence
we have about vitamins A and C comes from studies of these
vitamins as they are found in foods. That is why NCI
recommends that you eat a variety of foods rich in
vitamins rather than relying on vitamin supplements. Good
sources of vitamin A include yellow-orange vegetables such
as carrots, winter squash, sweet potatoes and pumpkin; and
yellow-orange fruits such as peaches, cantaloupes and
mangoes. Sources of vitamin C include dark-green leafy
vegetables such as kale, spinach, and watercress; broccoli
and asparagus; and tomatoes. Some fruit sources of vitamin
C are oranges, lemons, grapefruit, peaches, berries, and
cantaloupe.



* There is some evidence that vegetables in the cabbage
family may help protect against cancer of the colon. These
vegetables are also good sources of fiber, vitamins, and
minerals. Cabbage family vegetables include cabbage,
broccoli, cauliflower, Brussels sprouts, collards, kale,
turnips, mustard greens, turnip greens, kohlrabi,
watercress and radishes.


Reducing Your Risk of Heart Disease and Cancer


Based on what we know, the National Heart, Lung, and Blood
Institute and the National Cancer Institute have joined
together to suggest some ways you may reduce your risks of
heart disease and cancer. These suggestions emphasize the need
to eat a variety of foods each day. They also include some
"mealtime strategies" that you can use to plan meals that avoid
too much fat, saturated fat, cholesterol, and sodium, and that
help you to get adequate starch and fiber. These strategies are
consistent with the Department of Agriculture and Department of
Health and Human Services Dietary Guidelines for Americans.
These strategies should encourage you to think about the foods
you eat, how to prepare them, and what food choices you can
make when you go grocery shopping or eat away from home.


The key is following a Choose More Often approach. It
doesn't mean giving up your favorite foods. It means taking
steps to choose more often foods that are low in fat and high
in fiber. For example, if you enjoy eating steak, choose a
low-fat cut such as round steak, trim off the excess fat, broil
it, and drain off the drippings. Pizza? To try a low-fat
version that is rich in fiber, use a whole-grain English muffin
or pita bread topped with part-skim mozzarella, fresh
vegetables, and tomato sauce. And cookies or other desserts? In
many recipes you can reduce the fat, and substitute vegetable
oils or margarine for butter. To increase fiber, use whole
wheat flour in place of white flour.

Here's how the Choose More Often approach works:

Choose More Often:

Low-fat meat, poultry, fish

Lean cuts of meat trimmed of fat (round tip roast, pork
tenderloin, loin lamb chop), poultry without skin, and
fish, cooked without breading or fat added.

Low-fat dairy products

1 percent or skim milk, buttermilk; low-fat or nonfat
yogurt; lower fat cheeses (part-skim ricotta, pot, and
farmer); ice milk, sherbet.

Dry beans and peas

All beans, peas and lentils--the dry forms are higher in
protein.

Whole grain products

Breads, bagels, and English muffins made from whole wheat,
rye, bran, and corn flour or meal; whole grain or bran
cereals; whole wheat pasta; brown rice; bulgur.

Fruits and vegetables

All fruits and vegetables (except avocados, which are high
in fat, but that fat is primarily unsaturated). For
example, apples, pears, cantaloupe, oranges, grapefruit,
pineapple, peaches, bananas, carrots, broccoli, Brussels
sprouts, cabbage, kale, potatoes, tomatoes, sweet
potatoes, spinach, cauliflower, and turnips, and others.

Fats and oils high in unsaturates

Unsaturated vegetable oils, such as canola oil, corn oil,
cottonseed oil, olive oil, and soybean oil, and margarine;
reduced-calorie mayonnaise and salad dressings.

To assure an adequate diet, choose a variety of foods
daily including selections of vegetables; fruits; whole-grain
breads and cereals; low-fat dairy products; poultry, fish, and
lean meat, dry beans and peas. Here are some tips for following
the Choose More Often approach in three important areas:
grocery shopping, food preparation, and eating out.


Grocery Shopping


Focus on variety. Choose a wide selection of low-fat foods
rich in fiber. Include whole grain breads and cereals,
vegetables, fruits, low-fat dairy products, and poultry, fish,
and lean meat. Although the goal is to reduce fat to 30 percent
or less of calories, when choosing foods that do contain fat,
try to choose ones that contain primarily unsaturated fats. For
example, choose an unsaturated-rich margarine instead of
butter; choose vegetable oils.

Read food labels. To help you find foods that are low in
fat and cholesterol and high in fiber, get into the
label-reading habit. Many nutritional labels on packaged foods
show the amount of unsaturated and saturated fatty acids and
the amount of cholesterol and fiber they contain. Check the
type of fat on the ingredients list. Is it an animal fat,
coconut or palm kernel oil high in saturated fat? Or, is it
corn or soybean oil high in polyunsaturated fat? Choose a
product with the lowest proportion of saturated fat. The label
also tells you something else about a product. Ingredients are
listed in order of amount from most to least by weight. So,
when you buy a breakfast cereal, for example, choose one that
has a whole grain listed first (such as whole wheat or
oatmeal).

Pay attention to sodium. Many processed, canned, and
frozen foods are high in sodium. Cured or processed meats,
cheeses, and condiments (soy sauce, mustard, tartar sauce) are
also high in sodium. Check for salt, onion or garlic salt, and
any ingredient with "sodium" on the label. If the sodium
content is given on the nutritional label, compare products and
choose the ones with lower levels.


Food Preparation


Use small amounts of fat and fatty foods. There are lots
of ways to use less fat. For example, when you saute or
stir-fry, use only 1/2 teaspoon of fat per serving. When you
use margarine, mayonnaise, or salad dressing, use half as much
as usual. And, decrease portion sizes of other high fat
foods--rich desserts, untrimmed and fatty types of meat,
poultry with skin, and fried foods, especially breaded foods.



Use less saturated fat. While reducing your total fat
intake, substitute unsaturated fat and oils for saturated fat
in food preparation. For example, instead of butter, use
margarine or vegetable oil. One teaspoon of butter can be
replaced with equal portions (or less) of margarine or 3/4
teaspoon of vegetable oil in many recipes without affecting the
quality. Saturated fat may be reduced even more if you want to
experiment with recipes. Poultry without skin and fish are good
choices because they are often lower in fat and saturated fat
than many meats.

Use low-fat alternatives. Substitute 1 percent, skim, or
reconstituted nonfat dry milk for whole milk. Use low-fat
yogurt, buttermilk, or evaporated skim milk in place of cream
or sour cream. Try reduced-calorie mayonnaise and salad
dressing in place of regular.

Choose lean meat. When you buy meat, choose lean cuts such
as beef round, pork tenderloin, and loin lamb chops. Be sure to
trim all visible fat from meat and poultry and remove poultry
skin.

Use low-fat cooking methods. Bake, steam, broil,
microwave, or boil foods rafter than frying. Skim fat from
soups and gravies.

Increase fiber. Choose whole grain breads and cereals.
Substitute whole grain flour for white flour. Eat vegetables
and fruits more often and have generous servings. Whenever
possible, eat the edible fiber-rich skin as well as the rest of
the vegetable or fruit.

Use herbs, spices, and other flavorings. For a different
way to add flavor to meals, try lemon juice, basil, chives,
allspice, onion, and garlic in place of fats and sodium. Try
new recipes that use less fat or sodium-containing ingredients,
and adjust favorite recipes to reduce fat and sodium.


Eating Out


Choose the restaurant carefully. Are there low-fat as well
as high-fiber selections on the menu? Is there a salad bar? How
are the meat, chicken, and fish dishes cooked? Can you have
menu items broiled or baked without added fat instead of fried?
These are important things to know before you enter a
restaurant--fast food or otherwise. Seafood restaurants usually
offer broiled, baked, or poached fish, and you can often
request butter and sauces on the side. Many steak houses offer
small steaks and have salad bars.



Try ethnic cuisines. Italian and Asian restaurants often
feature low-fat dishes. though you must be selective and alert
to portion size. Try a small serving of pasta or fish in a
tomato sauce at an Italian restaurant. Many Chinese, Japanese,
and Thai dishes include plenty of steamed vegetables and a high
proportion of vegetables to meat. Steamed rice, steamed noodle
dishes, and vegetarian dishes are good choices too. Ask that
the chef cook your food without soy sauce or salt to decrease
sodium. Some Latin American restaurants feature a variety of
fish and chicken dishes that are low in fat.

Make sure you get what you want Here are just a few things
you can do to make sure you're in control when you eat out. Ask
how dishes are cooked. Don't hesitate to request that one food
be substituted for another. Order a green salad or baked potato
in place of french fries or order fruit, fruit ice, or sherbet
instead of ice cream. Request sauces and salad dressings on the
side and use only a small amount. Ask that butter not be sent
to the table with your rolls. If you're not very hungry, order
two low-fat appetizers rather than an entire meal, split a menu
item with a friend, get a doggie-bag to take half of your meal
home, or order a half-size portion. When you have finished
eating, have the waiter clear the dishes away so that you can
avoid postmeal nibbling.


Mealtime Strategies


We've given you some basic information on fat, fiber, and
sodium. And, we've provided some tips on decreasing fat,
saturated fat, cholesterol and sodium; and increasing fiber.
But, how do you put it all together when it comes to breakfast,
lunch, and dinner? These mealtime strategies should help.


Breakfast


Strategy #1--Choose fruit more often. Just a few great
choices in the fruit family are: cantaloupe, grapefruit,
strawberries, oranges, bananas, pears, and apples.

Strategy #2--Choose whole-grain cereals and products more
often. Examples are whole wheat or bran breads, bagels, and
cereal.

Strategy #3--Try making pancakes and waffles with whole
wheat flour instead of white flour and one whole egg and one
egg white rafter than two whole eggs. For a low-fat topping
with fiber, try applesauce, apple butter and cinnamon, or fruit
and low-fat plain yogurt.

Strategy #4--Fruit juice and skim milk are familiar
breakfast drinks. For an extra boost in the morning, why not
try a fruit smoothie made from juice, fruit and nonfat plain
yogurt blended together. Other nonfat choices are seltzer
water, coffee, and tea.

These breakfast choices are sound nutrition choices
because they are not only low in fat and cholesterol but also
provide fiber, vitamins, and minerals. Some foods that you
should choose less often are sausage, bacon, butter, whole milk
and cream (including commercial nondairy creamer). These foods
are high in saturated fat and cholesterol.



Lunch


Strategy #1--Try a fiber-rich bean, split pea, vegetable,
or minestrone soup. Use commercially canned and frozen soups
and cream soups less often--they can be high in sodium and fat.
If you make your own soup, use broth or skim milk to keep the
fat content low.

Strategy #2--Have a bean salad or mixed greens with plenty
of vegetables. For fiber include some vegetables like--carrots,
broccoli, cauliflower, and kidney or garbanzo beans. For a
low-fat dressing, try lemon juice or a reduced-calorie
dressing. If you use regular dressing, use only a very small
amount.

Strategy #3--Try sandwiches made with water-packed tuna,
sliced chicken, turkey, lean meat, or low-fat cheese, and use
whole-grain bread or pita bread. To decrease fat, use
reduced-calorie mayonnaise, or just a small amount of regular
mayonnaise, or use mustard. Mustard contains no fat.

Strategy #4--For dessert, have fresh fruit, low-fat
yogurt, or a frozen fruit bar.

Strategy #5--Fruit juice and skim milk are good beverage
choices. Club soda with a twist of lemon or lime, hot or iced
tea with lemon, or coffee without cream are refreshing drinks.



At lunch, try to eat these foods less often: processed
luncheon meats, fried meat, chicken, or fish; creamy salads,
french fries and chips, richer creamy desserts, high-fat baked
goods, and high-fat cheeses such as Swiss, cheddar, American,
and Brie.


Dinner


Strategy #1--Eat a variety of vegetables. To increase
variety, try some that might be new to you, such as those from
the cabbage family (broccoli, Brussels sprouts, cauliflower,
and cabbage), dark-green leafy vegetables (spinach and kale),
and yellow-orange vegetables (winter squash and sweet
potatoes). For old favorites, like peas and green beans, skip
the butter and sprinkle with lemon juice or herbs. Or, how
about a baked potato, with the skin, and topped with low-fat
yogurt and chives, tomato salsa, or a small amount of low-fat
cheese?

Strategy #2--Try whole wheat pasta and casseroles made
with brown rice, bulgur, and other grains. If you are careful
with preparation, these dishes can be excellent sources of
fiber and low in fat. For example, when milk and eggs are
ingredients in a recipe, try using 1 percent or skim milk,
reduce the number of egg yolks and replace with egg whites.
Here are some ideas for grain-based dishes:

--Whole wheat spaghetti with fresh tomato sauce;

--Whole wheat macaroni and chickpea stew in tomato sauce;

--Tuna noodle casserole, using water-packed tuna (or rinsed,
oil-packed tuna), skim milk, and fresh mushrooms or sliced
water chestnuts;

--Turkey, broccoli and brown rice casserole using skim milk
and egg whites;

--Eggplant lasagna, made with broiled eggplant and part-skim
mozzarella or ricotta cheese.

Strategy #3--Substitute whole-grain breads and rolls for
white bread.

Strategy #4--Choose main dishes that call for fish,
chicken, turkey or lean meat. Don't forget to remove the skin
and visible fat from poultry and trim the fat from meat. Some
good low-fat choices are:

--Red snapper stew;

--Flounder or sole florentine (make the cream sauce with
skim milk);

--Salmon loaf (use skim milk, rolled oats, and egg whites);

--Baked white fish with lemon and fennel;

--Chicken cacciatore Italian-style (decrease the oil in the
recipe);

--Chicken curry served over steamed wild rice (choose a
recipe that requires little or no fat; "saute" the onions
in chicken broth instead of butter);

--Light beef stroganoff with well-trimmed beef round steak
and buttermilk served over noodles;

--Oriental pork made with lean pork loin, green peppers and
pineapple chunks served over rice.



Strategy #5--Choose desserts that give you fiber but little
fat such as:

--Baked apples or bananas, sprinkled with cinnamon;

--Fresh fruit cup;

--Brown bread or rice pudding made with skim milk;

--Oatmeal cookies (made with margarine or vegetable oil; add
raisins).

For many, the end of the workday, represents a time to
relax, and dinner can be a light meal and an opportunity to
decrease fat and cholesterol.


Snacks


Strategy #1--Try a raw vegetable platter made with a
variety of vegetables. Include some good fiber choices:
carrots, snow peas, cauliflower, broccoli, green beans.

Strategy #2--Make sauces and dips with nonfat plain yogurt
as the base.

Strategy #3--Eat more fruit. Oranges, grapefruit, kiwi,
apples, pears, bananas, strawberries and cantaloupe are all
good fiber sources. Make a big fruit salad and keep it on hand
for snacks.

Strategy #4--Plain, air-popped popcorn is a great low-fat
snack with fiber. Watch out! Some prepackaged microwave popcorn
has fat added. Remember to go easy on the salt or use other
seasonings.

Strategy #5--Instead of chips, try one of these low-fat
alternatives that provide fiber: toasted shredded wheat Squares
sprinkled with a small amount of grated Parmesan cheese,
whole-grain English muffins, or toasted plain corn tortillas.

Strategy #6--When you are thirsty, try water, skim milk,
juice, or club soda with a twist of lime or lemon.

The National Heart, Lung, and Blood Institute and the
National Cancer Institute are committed to promoting good
health and reducing the loss of life from heart disease and
cancer. You can help. By using the ideas in this booklet,
trying recipes that have been modified to decrease fat and
sodium and increase fiber, and planning menus that are high in
fiber and low in fat, especially saturated fat, you may reduce
the risk of these diseases for yourself and for those you love.


So Eat Well, Eat Healthy... And Eat For Life!