“What is a healthy diet?” Many clinicians find themselves at a loss to answer this common question from patients. The difficulty of offering a simple answer is understandable. The overwhelming volume of data generated by food and nutrition researchers coupled with sometimes contradictory findings, the seeming flip-flops in recommendations, and the flood of misinformation in diet books and the media can make it seem as though explaining the essentials of healthy eating is akin to describing the intricacies of particle physics. That is unfortunate, because there are now enough solid strands of evidence from reliable sources to weave simple but compelling recommendations about diet.
DIETARY FAT
Dietary fat is a terribly misunderstood and mistakenly maligned nutrient. Myths and messages that have persisted since the 1960s warn that “fat is bad.” That dangerous oversimplification has helped launch dozens of largely ineffective diets and the development of thousands of fat-free but calorie-laden foods. It has also helped fuel the twin epidemics of obesity and type 2 diabetes. The message “fat is bad” is problematic because there are four main types of dietary fat with dramatically different effects on health.
Trans fats from partially hydrogenated oils are undeniably bad for the cardiovascular system and the rest of the body. These largely man-made fats elevate harmful low-density lipoprotein (LDL) cholesterol, reduce protective high-density lipoprotein (HDL) cholesterol, stimulate inflammation, and cause a variety of other changes that damage arteries and impair cardiovascular health.5 Higher intake of trans fat has been associated with an increased risk for developing cardiovascular disease, type 2 diabetes, gall stones, dementia, and weight gain.5 Saturated fats from red meat and dairy products increase harmful LDL, but also increase HDL. A moderate intake of saturated fat (under 8% of daily calories) is compatible with a healthy diet, whereas consumption of greater amounts has been associated with cardiovascular disease.
CARBOHYDRATES
In the United States, the reduction in the intake of dietary fat from 45% of calories in 1965 to approximately 34% today was accompanied by an increase in the intake of carbohydrates.8 These extra carbohydrates were largely in the form of highly processed grains. Processing removes fiber, healthful fats, and an array of vitamins, minerals, and phytonutrients, making processed grains such as white flour or white rice nutritionally impoverished compared with whole-grain versions. Consumption of a diet rich in highly processed grains is associated with an increase in triglycerides and a reduction in protective HDL.9 These adverse responses may be aggravated in the context of insulin resistance, which often develops during pregnancy. The prevalence of insulin resistance and type 2 diabetes are both increasing in the United States and around the world.
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