The Family Health Guide

Diet and health: Patterns matter most

It's nearly impossible for a person to have made it into the 21st century without understanding that you are what you eat. But understanding is one thing, making changes quite another. Often the barrier to change is a preoccupation with individual choices: Can I have eggs for breakfast? Is oatmeal better than raisin bran? If I order fish, can I get fries?

Individual choices are meaningful, but if they fit into a sound overall dietary pattern, there will be plenty of wiggle room, so you can eat at least some of the "bad" things you really love without worrying about the consequences.

Harvard studies of men

A report from Harvard's Health Professionals Follow-up Study examined the effect of dietary patterns on the health of 44,875 men. Instead of focusing on individual foods or nutrients, it used a 131-item food-frequency questionnaire to evaluate overall eating patterns. When the study began in 1986, all the men were 40–75 years old and none had been diagnosed with cardiovascular disease or cancer. In addition to dietary information, the volunteers also disclosed facts about their family medical histories, smoking, height, and weight. The researchers tracked the men to see if diet influenced the development of heart disease.

The scientists identified two overall dietary patterns. One was a typical American diet, characterized by a high consumption of red meat, processed meat, refined grains, sweets, and desserts. The other pattern was a "prudent" diet, high in fruits, vegetables, legumes, fish, and poultry.

The volunteers' diets were scored according to how closely they approached the American or prudent patterns. The results were striking: Men with the most American patterns were 64% more likely to develop heart disease than men with the most prudent diets. And in a follow-up study, the prudent diet was also linked to a lower risk of type 2 diabetes. These findings remained strong even after taking into account smoking, drinking, and obesity.

The Harvard study has the advantage of size (44,875 men) but the drawback of a relatively short duration (8 years). However, an earlier European study had the opposite mix, a long duration (20 years) and a modest sample size (3,045 men) — and it also reached the conclusion that a good dietary pattern pays off.

The women's world

In reports from the Nurses' Health Study, women who followed the prudent dietary pattern enjoyed a 24% lower risk of coronary artery disease and a 26% lower risk of ischemic stroke than women who consumed Western-style foods, even after considering other health habits and risk factors. And when women combined prudent eating with regular exercise and other good habits, they enjoyed a remarkable 83% reduction in the risk of coronary artery disease. The prudent diet was also linked to a significantly lower risk of colon cancer.

A pattern to live by

Does that tempting slice of fancy cheesecake live up to its reputation as "something to die for"? Not if it's a small part of a healthful dietary pattern.

Diet has a powerful impact on health, and the best diet features generous amounts of fruits, vegetables, legumes, whole grains, nuts and seeds, low-fat dairy products, olive oil, and fish. A healthful diet is also low in saturated fat from meat and whole dairy products; trans fatty acids from fried foods, snack foods, and commercially baked goods; salty foods; refined grains; and concentrated sweets. But that doesn't mean you have to eat spinach every day or that you have to turn down both hamburger and bun.

Evaluate your current diet, then set goals based on the pattern that will keep you healthy. Change slowly but steadily. By focusing on an overall pattern, you'll be able to find plenty of healthful foods you really like instead of forcing down squash or walnuts, like them or not. And you'll also be able to eat the foods that matter to you most, even if they're on the "bad" list — as long as the size of your portion is reasonable and your overall dietary pattern is sound.

August 2006 Update