Harvard Men's Health Watch

Diet and health: Patterns matter most

The average American guy grew up believing that real men don't eat broccoli or, for that matter, salmon. He was weaned to franks and burgers, with steak or roast on Sunday — accompanied, of course, by catsup and fries. Start the day with bacon and eggs, share some doughnuts at the office, snack on chips and dip, enjoy a bowl of ice cream on the way to bed — it's the all-American way to eat.

It's nearly impossible for a man 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 men can eat at least some of the "bad" things they 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 providing their medical histories and 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. In both cases, these associations remained strong even after the scientists adjusted the findings for smoking, drinking, and obesity (more common in the men who followed the American pattern) as well as vitamin use and exercise (more prevalent with the prudent pattern).

A European study of men

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 European research enrolled men from Italy, Finland, and the Netherlands. When it started in 1970, all the men were between the ages of 50 and 70. Each volunteer provided detailed dietary information along with facts about his smoking and drinking. The scientists used standards developed by the World Health Organization to evaluate dietary patterns. The healthful pattern included a low to moderate consumption of four nutrients (cholesterol, less than 300 mg a day; saturated fat, less than 10% of calories; protein, 10%–15% of calories; and simple carbohydrates, less then 10% of calories) and a moderate to high intake of five others (polyunsaturated fat, 3%–7% of calories; dietary fiber, 27–40 grams a day; complex carbohydrates, 50%–70% of calories; fruits and vegetables, more than 400 grams a day; and nuts and seeds, more than 30 grams a day). Over the 20 years, men who met the healthful dietary standard came out ahead — way ahead, in fact. All in all, the men with the best diets had a 13% lower mortality rate than the men with the worst diets, even after smoking and drinking were factored in. And although individual food preferences were very different in the three countries, the overall pattern held up; sad to say, the typical American style of eating was as harmful in Europe as in the United States.

The women's world

Harvard University is coeducational, and Harvard's medical scientists study women as well as men. 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. 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.

The Harvard studies of men and women evaluated dietary patterns and the risk of disease, while the European study of men investigated the even more important link between diet and death. A study of 42,254 American women also used longevity as the benchmark for a healthful dietary pattern. The research, which was sponsored by the National Cancer Institute, used a 62-item questionnaire to assess dietary patterns; like the studies of men, it also collected a broad range of health information. The scientists tracked the volunteers for an average of more than five years. During that time, the women who ate the most healthful diets enjoyed a 30% lower risk of death than the women who ate the least well, even after other health habits and risk factors were taken into account. Similarly, a 2004 study of 2,339 men and women found that a good dietary pattern was associated with a more than 50% lower death rate, even though the subjects in this 11-nation European study were 70–90 years old.

Men may be from Mars, women from Venus — but here on Earth, both benefit from healthful eating habits.

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.

Men don't eat nutrients, they eat food. Most often, in fact, they don't eat individual foods but meals. That means nutrients mix and interact, for better or worse.

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.

When it comes to diet, men who understand the big picture can sketch in the details that will brighten the canvas of daily life.