by Dr. John Neustadt

Any discussion about health would be incomplete without mentioning the important role of healthy food and proper nutrition. Food contains the vital nutrients required for our bodies to function, but there are several reasons why most people become deficient in nutrients as they age. One simple reason is that people do not eat an optimal diet.

Your dietary pattern—what you eat day after day, month after month, year after year—is more predictive than genetics and family history for developing chronic diseases and dying early. In fact, as I teach in book, Fracture-Proof Your Bones: A Comprehensive Guide to Osteoporosis, simply eating the right way has been associated with lower risk of getting osteoporosis and a 21% reduction in fracture risk.

Even though most people understand they should eat healthier, the Standard American Diet (SAD) is rich in calories and poor in nutrition. It’s characterized by consuming high amounts of baked goods, fried foods, sodas and packaged foods full of high-fructose corn syrup, artificial flavors, artificial sweeteners, food dyes, partially hydrogenated oils (trans fatty acids), preservatives and other additives.

The US Centers for Disease Control and Prevention (CDC) concluded that more than 60% of chronic diseases are caused by poor diet and lifestyle. If you’re eating like most Americans, you’re overfed and malnourished, creating the perfect environment in your body for developing chronic diseases and shaving years off your life.

The average American consumes around 2,700 calories per day and eats about a ton (nearly 2,000 pounds) of food every year. If all of it were healthy, nutritious food, that would be fantastic. But it’s not. In 2014 alone, Americans ate 20 billion donuts. That’s 63 donuts per person. And since I don’t eat donuts, someone else is eating my share. Love ice cream? Apparently so do a lot of other folks—to the tune of 15 billion pints (47 pints per person) a year.

Processed foods such as white rice, pasta, potato chips and baked goods that use white flour are nearly devoid of vitamins and minerals. These foods, which are consumed in large quantities in the US, are nutritionally deficient. For example, about 85% of magnesium and 60% of calcium are lost during the process of refining wheat to make white flour for breads, muffins, cookies and pizza dough.

The naturally occurring nutrients are stripped out during the processing of these foods by removing the more nutrient-dense portion of the grain and applying heat during the manufacturing process that destroys vitamins. Looking for naturally occurring good nutrition in these over-processed foods is like looking for water in the desert. It’s a mirage that just isn’t there. Given this unhealthy dietary patterns, the irony is that millions of Americans are overfed but malnourished.

There’s only so much food we can eat, so if you’re filling up with highly processed, nutrient-poor foods, you’re not eating enough healthy foods. Data collected by the CDC’s Behavioral Risk Factors Survey in 2015 revealed that 40% of US adults eat less than 1 fruit and 22% eat less than 1 vegetable per day.

These poor eating habits are the largest contributor to the epidemic of chronic diseases in the US. Approximately 50% of all adults in the US have 1 or more chronic diseases, including diabetes, arthritis, heart disease or cancer. Of the top 10 causes of death, 7 are chronic diseases, and 2 of these—heart disease and cancer—account for nearly half of all US deaths. More than 66% of US adults are overweight or obese and 33% of children are also overweight or obese. Research suggests that lifestyle factors are responsible for 80% of the most common cancers in the US (breast, prostate and colon) as well as 1 in 3 cancer deaths.

Raw Material for Life

Food has such a profound influence on health because food, our biochemistry and our health are inextricably linked. Food supplies the raw materials for our biochemistry. While people get entire PhD’s in biochemistry, and the details get complicated, biochemistry very simply refers to how the body uses vitamins, minerals, amino acids, fats and phytonutrients to do its job. Biochemistry also refers to how things like nutritional deficiencies, food allergies, infections and environmental toxins can interrupt our proper biochemical function and create symptoms and diseases.

The mineral magnesium, for example, is used for more than 350 biochemical processes. It’s important for producing the mood elevating hormone serotonin, for muscle relaxation, to generate cellular energy and is involved in the repair and replication of DNA.  When you provide your body optimal nutrition, it functions better. When there’s not enough magnesium for your body to work optimally, things can start to go wrong.

The richest sources of magnesium are green, leafy vegetables such as lettuce, Swiss chard and kale. The molecule that allows plants to turn sunlight into energy is called chlorophyll, and it’s what gives the green color to these plants. At the center of every chlorophyll molecular is one atom of magnesium. Since people following the SAD diet don’t eat enough whole, plant-based foods, choosing instead highly processed and packaged foods, it’s not surprising that more than half of Americans aren’t consuming even the minimum amount of magnesium required for our bodies to function optimally.

Even though nutrients are typically discussed in isolation—for example, protein and fats—in foods they occur together. Generally speaking, protein is protein. But fats that accompany protein in many foods, such as nuts, beef and fish don’t all affect the body in the same way.

Fatty acids surround every cell in our bodies and are crucial for proper cell functions. There are two major classes of fatty acids—omega-3 fatty acids and omega-6 fatty acids. Omega-3 fatty acids are anti-inflammatory, while omega-6 fatty acids promote inflammation and heart disease. Omega-3 fatty acids are found in high amounts in plant oils and cold-water fish, while meats (e.g., beef) contain higher amounts of omega-6 fatty acids.

Different concentrations of fatty acids exist in foods, and both omega-3 and omega-6 fatty acids are required for proper health. However, the SAD contains too much omega-6 fatty acid and too little omega-3 fatty acid. This unfavorable ratio promotes inflammation.

Many diseases that were once thought to be unrelated have been found to result from inflammation. Arthritis, autoimmune disease, diabetes, high blood pressure, heart disease, dementia and other chronic diseases fall into a broader category of “inflammatory diseases.”

Nutrients in food feed the biochemical pathways that control inflammation. The 2 major types of essential (meaning your body cannot produce them and they have to come from diet or dietary supplements) fatty acids, omega-6 and omega-3, have opposite effects on inflammatory pathways. The body converts omega-6 fats into inflammatory chemicals, while omega-3 fatty fats create anti-inflammatory chemical messengers. The SAD diet, which is high in beef and low in fish, provides 16 to 30 times more omega-6 than omega-3 fatty acids. This ratio of omega-6 fatty acids to omega-3 fatty acids makes the SAD diet an eating pattern that promotes inflammation and inflammatory diseases. Trans fatty acids, which are present in many packaged foods consumed in the SAD diet, also directly contribute to inflammation.

In addition to dietary fats, refined carbohydrates and sugar profoundly affect our biochemistry. Foods made with refined white flour and sugar disrupt blood sugar levels and can lead to insulin resistance, inflammation and the production of damaging free radicals. Although too much sugar of any kind can disrupt the body’s biochemistry, studies that compare the effects of regular table sugar to fructose suggest that high consumption of fructose is a more potent trigger of inflammation. High-fructose corn syrup is the first ingredient in soda as well as a common ingredient in many packaged foods—including breakfast cereal, granola bars, sweetened yogurt, fruit juice cocktails, spaghetti sauce, salad dressings and ketchup.

The SAD diet may promote inflammation, but a whole-foods, plant-based diet that emphasizes consuming more fish and lean protein such as chicken, does the opposite. The dietary pattern that has been most studied and shown consistently to promote health and reduce disease risk is the Mediterranean Diet. A randomized controlled trial, published in the Journal of the American Medical Association (JAMA) in 2004, found that following the Mediterranean Diet Pattern resulted in lower levels of inflammatory chemicals in the blood, a decrease in insulin resistance and improved cardiovascular health.

Food Controls Genetic Expression

In addition to the direct effects nutrition has on biochemical pathways, food powerfully influences genetic health and genetic expression because it contributes to the microenvironment within cells. Epigenetics is the study of how diet and other environmental exposures affect genetic expression without changing the DNA itself. One mechanism involved in epigenetics is DNA methylation—a process that relies on nutrients like folic acid, vitamin B12 and vitamin B6.

Cancer was the first chronic disease to be linked to epigenetics when researchers discovered in 1983 that genes of colorectal cancer cells were under-methylated when compared with normal cells. Since that time, scientists have discovered that epigenetic changes may contribute not only to cancer but also to heart disease, obesity, depression, diabetes and dementia.

The knowledge of how foods influence genetic expression is in its infancy, but what we already know is fascinating. For example, resveratrol in grapes promotes methylation to reduce the risk of prostate cancer and breast cancer; zinc inhibits expression of genes that lead to inflammation and cancer; and omega-3 fatty acids promote expression of genes that block tumor progression. In contrast, trans fatty acids lead to under-methylation and an increased risk of invasive breast cancer.

Epigenetic changes can occur from the time a fetus is in its mother’s womb until the day a person dies. That means that dietary changes you make now can influence your genetic expression and alter your risk of chronic disease from this day forward.

Nutrient Deficiencies Damage DNA

The SAD diet is dramatically different than the diet consumed by our ancestors. Whereas our ancestors ate primarily a plant-based diet that contained no processed foods, the modern SAD diet relies heavily on processed foods. When compared with traditional diets, the modern diet provides more calories, refined carbohydrates, saturated fatty acids (fats that are solid at room temperature), trans fatty acids and sodium but less minerals, protein, omega-3 fatty acids, fiber, potassium, vitamin B2, vitamin B3, folate, vitamin A, vitamin C and vitamin E. In other words, the modern diet is calorie-rich but nutrient-poor.

Micronutrients, which include vitamins and minerals, are depleted in foods that are staples of the SAD diet. The process of refining flour, for example, strips wheat of more than 80% of many B vitamins, 85% of magnesium and 60% of the calcium that was present in the whole grain. Even the fruits and vegetables that are consumed in the United States are lower in vitamins and minerals than they once were. Industrialized farming practices create nutrient-poor soil and food with lower amounts of nutrients compared to conventionally farmed food.

Studies show that 93% of all Americans consume less than the estimated average requirement of vitamin E, 56% consume less than the average requirement of magnesium, 31% consume less than the average requirement of vitamin C and 12% consume less than the average requirement of zinc. Over time, eating foods that are calorie-dense but nutrient-poor can create micronutrient deficiencies.

Micronutrient deficiencies cause serious problems. Research conducted by Dr. Bruce Ames, PhD, one of the world’s foremost biochemist and a member of the US National Academy of Sciences, proves that deficiencies of vitamin B12, B6, C, E, folate, niacin, iron or zinc can create breaks in DNA that mimic damage from x-ray radiation. Folate deficiency is estimated to create DNA damage in as much as 10% of the US population, which can contribute to increasing colon cancer risk.

Micronutrient deficiencies also damage mitochondria. Mitochondria create celullar energy, and damage to mitochondria is now implicated in dozens of diseases, including cardiovascular disease, diabetes, dementia, Parkinson Disease and cancer. Deficiencies in minerals, such as magnesium and zinc, can cause mitochondrial dysfunction, DNA damage and metabolic changes that contribute to chronic, degenerative disease.

Diet Cures Disease

While the SAD diet disrupts biochemistry and creates a cellular microenvironment that leads to genetic damage and chronic disease, the good news is that following a healthier eating pattern can do just the opposite. Research conducted over the last 50 years proves that healthy eating reduces the risk of chronic diseases and can reverse or even cure existing diseases. Plus, since diet provides the raw materials for all our metabolic processes, eating healthy makes you feel and look better too.

Clinical trials unambiguously show that a whole-foods, plant-based diet can reverse the #1 killer in the US—cardiovascular disease. Dr. Caldwell Esselstyn, MD, at the Cleveland Clinic in Ohio had patients avoid oils, meat, fish, poultry and dairy products. These simple diet changes reduced cholesterol nearly 50%, from an average of 246 mg/dL to 132 mg/dL and clogged arteries opened in 70% of patients. Dr. Dean Ornish in California showed that a low-fat diet (providing less than 10% of total calories from fat) with unlimited amounts of fruits, vegetables and whole grains along with small amounts of egg whites, nonfat milk and yogurt decreased cholesterol levels by about 25%, from 227 mg/dL to 172 mg/dL and decreased symptoms of chest pain by 91%. The results from these clinical trials are better than any medications, don’t pose any risks of side effects that people get with the drugs and is a whole lot cheaper.

While the diets prescribed by Drs. Esselstyn and Ornish to reverse cardiovascular disease are quite restrictive, simply following a Mediterranean Diet Pattern has shown incredible benefits. A meta-analysis of randomized controlled trials, published in the British Medical Journal in 2015, evaluated the effect of the Mediterranean Diet Pattern in patients either with type 2 diabetes or metabolic syndrome. The analysis reported that following the Mediterranean Diet Pattern increased the probability of remission from metabolic syndrome by 49% and reduced the risk of future diabetes by 19% to 23%. Three of the clinical trials included in the analysis evaluated blood sugar control in patients with type 2 diabetes, and the overall results showed that the Mediterranean diet reduced hemoglobin A1c (HbA1c) levels by an average of 0.47%—demonstrating improved blood sugar balance. Reducing HbA1c by just 0.5% decreases cardiovascular disease risk by 10%.

A Mediterranean Diet has also been shown to reverse the course of nonalcoholic fatty liver disease (NAFLD). NAFLD, which is commonly present in patients with metabolic syndrome, diabetes or obesity, can put a person at risk of developing liver cirrhosis and liver cancer. In a randomized, controlled clinical trial published in 2017, researchers showed that the Mediterranean Diet reversed the NAFLD from moderate to severe disease to mild or absent in 36% of patients after just 6 months. These studies show that you can use food as medicine.

Diet Prevents Disease

Diet not only reverses the course of existing disease but can also reduce the risk of developing a chronic disease in the first place. Once again, of all the diets out there, the Mediterranean Diet has been the most extensively studied and has repeatedly been shown to reduce the risk of obesity, metabolic syndrome, diabetes, atherosclerosis, heart disease, osteoporosis, cancer, death from cancer, cognitive disorders and all-cause mortality.

A 2017 meta-analysis found that following the Mediterranean Diet increases bone mineral density and reduces the risk of osteoporotic hip fractures by as much as 21%. This dietary pattern may also reduce the risk of Parkinson’s disease and Alzheimer’s disease by 13%. Studies even show that the Mediterranean Diet protects against death from chronic disease: it reduces deaths from heart disease by 9%, reduces deaths from cancer by 6%, and reduces overall mortality by 9%.

What You Can Do

The science is clear. When we follow a whole-foods, plant-based diet rich in lean proteins, we have the power to reduce our risk of disease and reverse the course of existing disease. The most extensively researched dietary pattern repeatedly shown to help people reach this goal is the Mediterranean Diet.

The Mediterranean Diet is based on the traditional eating patterns of the countries of Crete, Greece and Southern Italy. It emphasizes vegetables, fruits, whole grains, nuts and seeds, beans, lean meats, fish, olive oil, eggs, cheese and yogurt along with occasional intakes of red meat, sweets and wine. In contrast to the SAD diet, the Mediterranean Diet provides a high density of vitamins, minerals, fiber and healthy fats. The nuts, seeds, fish and olive oil provide a more favorable ratio of omega-3 to omega-6 oils and a more favorable ratio of monounsaturated to saturated fats. The Mediterranean Diet is promoted by the Harvard School of Public Health and the World Health Organization, who collaborated with Oldways Preservation and Trust in the 1990s to create the first Mediterranean Diet Food Pyramid.

The Mediterranean Diet Pattern is not a fad or a quick fix, but rather a pattern of eating for life. If you’re currently eating more of a SAD diet, I recommend you transition into a new eating pattern slowly, over perhaps six to eight weeks. You’ll need to learn new ways of shopping, cooking and preparing foods. Your taste buds will need to adjust to new spices and flavors. Radical changes made overnight are not sustainable, so it is best to ease into the new style of eating.

But don’t worry, I’ve created a simple system that will help you transition into eating this way. Follow my 3-Steps to Eating Healthy for Life and make eating healthy a habit.

Additionally, research has shown that conventionally grown foods have lower amounts of nutrients and higher amounts of pesticide residues compared to organic foods. Even if you’re not buying all organic foods, can still do a lot to eat healthier by simply avoiding the Dirty Dozen—the 12 most contaminatd foods.

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