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!