If you are overweight or have obesity, losing weight can improve your health. It might also help you prevent weight-related diseases, such as heart disease, diabetes, arthritis and some cancers. A healthy diet is an important part of a weight-loss program. It

• May include fruits, vegetables, whole grains, and fat-free or low-fat milk and milk products
• May include lean meats, poultry, fish, beans, eggs and nuts
• Goes easy on saturated fats, trans fat, cholesterol, salt (sodium), and added sugars

The key to losing weight is to burn more calories than you eat and drink. A diet can help you to do this through portion control. There are many different types of diets. Some, like the Mediterranean diet, describe a traditional way of eating from a specific region. Others, like the DASH eating plan or a diet to lower cholesterol, were designed for people who have certain health problems. But they may also help you to lose weight. There are also fad or crash diets that severely restrict calories or the types of food you are allowed to eat. They may sound promising, but they rarely lead to permanent weight loss. They also may not provide all of the nutrients your body needs.

In addition to a diet, adding exercise into your daily life can help you to lose weight.

Healthy eating is important at every life stage. Nutrient needs vary over the lifespan and each life stage has unique implications for food and beverage choices and disease risk. A healthy dietary pattern can help people achieve and maintain good health and reduce the risk of major chronic diseases such as heart disease, type 2 diabetes, osteoporosis, obesity, and some cancers.  

The Dietary Guidelines for Americans, 2020-2025 encourages individuals to focus on healthy eating patterns from birth through older adulthood by making changes in their food and beverage choices to help achieve and maintain a healthy weight, promote health, and prevent disease. The core elements of a healthy dietary pattern are remarkably consistent across the lifespan and across health outcomes. The Dietary Guidelines provides four overarching Guidelines to Make Every Bite Count:  

• Follow a healthy dietary pattern at every life stage. 

• Customize and enjoy nutrient-dense food and beverage choices to reflect personal preferences, cultural traditions, and budgetary considerations. 

• Focus on meeting food group needs with nutrient-dense foods and beverages and stay within calorie limits. 

• Limit foods and beverages higher in added sugars, saturated fat, and sodium, and limit alcoholic beverages. 

The Guidelines are supported by Key Recommendations that provide further guidance on healthy eating across the lifespan.

There are three key dietary principles that accompany the Guidelines and Key Recommendations:  

• Meet nutritional needs primarily from nutrient-dense foods and beverages. 

• Choose a variety of options from each food group. 

• Pay attention to portion size. 

Individuals and families are encouraged to make healthy lifestyle choices today. The benefits of healthy eating add up over time, bite by bite. Small changes matter. It’s important to eat a variety of fruits, vegetables, grains, protein foods, and dairy and fortified soy alternatives. When deciding what to eat or drink, choose options that are full of nutrients.  

• Make half your plate fruits and vegetables: focus on whole fruits and vary your veggies 

• Make half your grains whole grains. 

• Vary your protein routine.  

• Move to low-fat or fat-free dairy milk or yogurt (or lactose-free dairy or fortified soy versions). 

Make every bite count by following these tips: 

• Learn how much you need from each food group. 

• Take a look at your current eating routine. Pick one or two ways that you can switch to choices today that are rich in nutrition. 

• A healthy eating routine can help boost your health today and in the years to come. Think about how your food choices come together over the course of your day or week to help you create a healthy eating routine. 

• It’s important to eat a variety of fruits, vegetables, grains, protein foods, and dairy and fortified soy alternatives. Choose options for meals, beverages, and snacks that have limited added sugars, saturated fat, and sodium. 

Meet healthy eating goals one at a time!

Through social media, newspapers, magazines, and friends and coworkers, we are bombarded daily with advice on how to eat. A new fad diet always gains momentum, promising a solution to all of our health problems. Not surprisingly, our patients often have specific questions about these popular diets. Here is basic information about a number of noteworthy diets, along with relevant research.

Anti-Inflammatory Diet

Like other healthy diets, the anti-inflammatory diet encourages eating whole foods, healthy fats (particularly omega-3 fats), and whole grains. The diet also recommends minimizing pro-inflammatory foods such as red meats, processed/boxed foods, and dairy fats. Evidence suggests that an anti-inflammatory diet reduces the risk of disease, such as cancer, cardiovascular disease, and asthma. Studies also show positive results for chronic pain, inflammatory bowel disease, and osteoporosis. Future research is expected to show improvement for autoimmune diseases as well.

Summary: This diet is a useful adjunct treatment for chronic diseases but can also be used as a general dietary recommendation due to reduction in cancer and cardiovascular risk.

Elimination Diet

The elimination diet involves journaling food intake, watching for a correlation between foods and unwanted symptoms, and then removing possible culprits from the diet for a set period of time, usually 2-3 weeks. Foods are then reintroduced into the diet systematically to see if symptoms recur. For example, one food may be added back every three days to see if it triggers symptoms. This information is then used to create a new eating pattern. There has been positive research for the elimination diet for rheumatoid arthritis, irritable bowel syndrome (IBS), migraines, atopic dermatitis, ADHD, and other diagnoses.

Summary: This diet can be used to treat specific chronic diseases, especially when triggers are unknown. It is worth a try when other causes of symptoms are not clear.

Mediterranean Diet

The Mediterranean diet draws from traditional eating patterns in countries surrounding the Mediterranean Sea. It emphasizes fruits, vegetables, legumes, and whole grains. Dairy and meats are limited, with most animal protein coming from fish. Olive oil is used for cooking. An important aspect of the Mediterranean approach to eating is enjoying meals in the company of others. When compared to low-fat diets, Mediterranean diets are more effective in sustaining long-term improvements in inflammatory markers and cardiovascular risk factors like blood pressure and weight. Further studies have shown similar outcomes, including improved fasting glucose and markers for metabolic syndrome. In essence, the Mediterranean diet is in fact also an anti-inflammatory diet.

A study in the Annals of Internal Medicine showed that women who followed a Mediterranean-type diet were less likely to develop many types of cancer, diabetes, and Parkinson’s disease. They were also less likely to experience physical and cognitive decline and brain atrophy. Furthermore, the diet was associated with reduced telomere shortening, which suggests that it can increase longevity.

Summary: This diet may be the best-studied diet for overall longevity and reduction of chronic diseases. Like the anti-inflammatory diet, it has also been studied for specific diagnoses. Overall, the diet is very similar to the anti-inflammatory diet.

Paleolithic Diet

The Paleolithic, or “Paleo,” diet is designed to be similar to the diet of our Paleolithic hunter-gatherer ancestors, based on the logic that our genes are evolutionarily adapted to this diet. Critics of the diet emphasize that the Paleo diet’s assumptions about the types of foods eaten in the “old stone age” are incorrect. Specifically, animals were significantly different from their modern ancestors (notably, less plump). Vegetables were smaller and unpalatable until farming during the Neolithic period. And grains such as corn were wild grasses with tough kernels. Additionally, the average lifespan was less than 30 years, so we cannot conclusively say that the diet promoted longevity.

Overall, this eating pattern allows more animal protein than the Mediterranean diet, in the form of lean meats, but it also emphasizes fruits, nonstarchy vegetables, fish, nuts, and seeds. The diet discourages eating grain, dairy, legumes, processed foods, refined oils, and sugars. There is a lot of hype surrounding this diet, and research has been limited until recently. A 2020 meta-analysis concluded that the Paleolithic diet concluded it was comparable to the Mediterranean and two other diets in terms of its effects on blood glucose and insulin balance. Another meta-analysis concluded that there is some suggestion of favorable effects on cardiovascular disease risk factors, but more well-designed trials are still needed.

Summary: Positive aspects of this diet include a focus on fruits and vegetables and reduction of processed foods. However, research, while showing some initial promise, is limited.

Vegetarian/Vegan Diets

Vegetarians do not eat meat, fish, or poultry. Vegans avoid meat and all other animal products such as cheese, dairy, honey, and eggs. People generally become vegetarian or vegan for health, environmental, economic, or ethical concerns. A well-balanced vegetarian diet meets all known nutrient needs (including daily protein intake). Observational studies suggest that vegetarians enjoy better health, but this finding can be attributed to a multitude of confounding factors related to healthy lifestyles. More rigorous studies have found that vegetarians have decreased incidence of cardiac disease, and vegans with type 2 diabetes have better glycemic control than diabetics who eat meat. Research also supports a vegetarian or vegan diet for weight loss, reduction of systolic and diastolic blood pressure, and prevention and treatment of diabetes. A small study also reported improvements in neuropathic pain in type 2 diabetics following a vegan diet. One common nutritional deficiency among vegans is vitamin B12 deficiency. Vegans can either take supplemental Vitamin B12 or cook with nutritional yeast, which is rich in B12.

Summary: Both vegetarian and vegan diets prevent cardiac and metabolic disease and can result in weight loss. If balanced and low in processed foods, a vegetarian and vegan diet can meet all of a person’s nutritional needs.

Blood Type Diet

The blood type diet outlined in the book Eat Right 4 Your Type by Peter D’Adamo, suggests that one’s blood type is the main determinant of a person’s dietary needs. The book suggests different approaches to eating for each blood type. Vegetables and legumes are encouraged for most of the blood types and certain foods are excluded for each blood type. Minimal research has been conducted to assess the validity of this diet. A 2014 study with 1,455 participants showed modest improvement in cardiometabolic markers in patients following the diet, but these improvements were not specific to particular blood types.

Summary: Elements of this diet support healthy evidence-based dietary recommendations such as consumption of vegetables, seeds, and legumes, but there is no evidence suggesting benefit from adhering to the recommendations for each specific blood type.

DASH Diet

DASH stands for dietary approaches to stop hypertension. It was initially recommended for those with hypertension or at risk for it, but subsequent studies have found that this diet is also helpful for improving cholesterol levels and insulin sensitivity. The diet encourages high intake of fruits, vegetables, nuts, and seeds, with minimal consumption of animal meats, dairy, saturated fats, and sweets. The goal is to consume 2,000 calories per day. In hypertensive patients, following the DASH diet resulted in a drop in systolic pressure of 11.6 mm Hg and a drop in diastolic pressure of 5.8 mm Hg.

Summary: Like the anti-inflammatory and Mediterranean diets, this diet encourages high intake of fruits, vegetables, nuts, and seeds along with low intake of meat and dairy. This could be used as both a general dietary recommendation and in the setting of specific diagnoses, such as hypertension and dyslipidemia.

Diets for Weight Loss

When patients look for guidance regarding weight loss, it is beneficial to look at their current health issues for guidance about focusing on a low-fat versus a low-carbohydrate approach. Decreasing overall calories is, of course, necessary for sustained weight loss, but for patients with diabetes or insulin resistance (an estimated 23% of the U.S. population), a low-carbohydrate diet like the Atkin’s diet may prove to be the most effective for them. For those with normal insulin sensitivity, high-carbohydrate, low-fat diets may prove more effective.

Those on low-carbohydrate diets have greater success when eating leaner proteins and avoiding saturated fats. Likewise, those on high-carbohydrate, low-fat diets find increased success when their carbohydrates are primarily fruits, vegetables, whole grains, and multigrain. In this way, the foods we use to replace carbohydrates or fats in low-carb and low-fat diets seem to matter more than the diet choice itself. In fact, studies have shown that over time, low-fat and low-carb diets have similar weight loss outcomes.

Summary: The best strategy for long-term weight loss is a sustainable diet. The success of low-carbohydrate and low-fat diets depends on the types of nutrients we use to replace the carbohydrates and fats.

Many studies have looked at the possibility that specific dietary components or nutrients are associated with increases or decreases in cancer risk. Studies of cancer cells in the laboratory and of animal models have sometimes provided evidence that isolated compounds may be carcinogenic (or have anticancer activity).

But with few exceptions, studies of human populations have not yet shown definitively that any dietary component causes or protects against cancer. Sometimes the results of epidemiologic studies that compare the diets of people with and without cancer have indicated that people with and without cancer differ in their intake of a particular dietary component.

However, these results show only that the dietary component is associated with a change in cancer risk, not that the dietary component is responsible for, or causes, the change in risk. For example, study participants with and without cancer could differ in other ways besides their diet, and it is possible that some other difference accounts for the difference in cancer.

When evidence emerges from an epidemiologic study that a dietary component is associated with a reduced risk of cancer, a randomized trial may be done to test this possibility. Random assignment to dietary groups ensures that any differences between people who have high and low intakes of a nutrient are due to the nutrient itself rather than to other undetected differences. (For ethical reasons, randomized studies are not generally done when evidence emerges that a dietary component may be associated with an increased risk of cancer.)

Scientists have studied many additives, nutrients, and other dietary components for possible associations with cancer risk. These include:

• Acrylamide
  Acrylamide is a chemical found in tobacco smoke and some foods. It can be produced when certain vegetables, such as potatoes, are heated to high temperatures. Studies in animal models have found that acrylamide exposure increases the risk for several types of cancer. However, there is no consistent evidence that dietary acrylamide exposure is associated with the risk of any type of cancer in humans.
• Alcohol
  Although red wine has been suspected of reducing cancer risk, there is no scientific evidence for such an association. Also, alcohol is a known cause of cancer. Heavy or regular alcohol consumption increases the risk of developing cancers of the oral cavity (excluding the lips), pharynx (throat), larynx (voice box), esophagus, liver, breast, colon, and rectum. The risk of developing cancer increases with the amount of alcohol a person drinks.
• Antioxidants
  Antioxidants are chemicals that block the activity of other chemicals, known as free radicals, that may damage cells. Laboratory and animal research has shown that exogenous antioxidants can help prevent the free radical damage associated with the development of cancer, but research in humans has not demonstrated convincingly that taking antioxidant supplements can help reduce the risk of developing or dying from cancer. Some studies have even shown an increased risk of some cancers.
• Artificial sweeteners
  Many studies have been conducted on the safety of the six FDA-approved artificial sweeteners (saccharin, aspartame, acesulfame potassium, sucralose, neotame, and advantame). In laboratory animal studies, these sweeteners have generally not been found to cause cancer or other adverse health effects. Most studies of the association between artificial sweetener intake and cancer in humans have also shown no increase in risk, although one large cohort study found a slight increase in cancer risk among users of several sweeteners.
• Charred meat
  Certain chemicals, called HCAs and PAHs, are formed when muscle meat, including beef, pork, fish, and poultry, is cooked using high-temperature methods. Exposure to high levels of HCAs and PAHs can cause cancer in animals; however, whether such exposure causes cancer in humans is unclear.
• Cruciferous vegetables
  Cruciferous vegetables contain chemicals known as glucosinolates, which break down into several compounds that are being studied for possible anticancer effects. Some of these compounds have shown anticancer effects in cells and animals, but the results of studies with humans have been less clear.
• Fluoride
  Fluoride in water helps to prevent and can even reverse tooth decay. Many studies, in both humans and animals, have shown no association between fluoridated water and cancer risk.
• Tea
  Tea contains polyphenol compounds, particularly catechins, which are antioxidants. Results of epidemiologic studies examining the association between tea consumption and cancer risk have been inconclusive. Few clinical trials of tea consumption and cancer prevention have been conducted and their results have also been inconclusive.
• Vitamin D
  Vitamin D helps the body use calcium and phosphorus to make strong bones and teeth. Possible associations of blood levels or intakes of vitamin D with cancer have been studied in both observational studies and randomized trials. Observational studies have provided some evidence that people with higher blood levels of vitamin D might have lower risks of colorectal cancer and of overall cancer mortality. Most randomized trials have not found an association between vitamin D supplement use and cancer risk or mortality.

Inflammation is one of the body’s ways of protecting itself.  It helps fight off infections, increases blood flow to places where healing is needed, and signals us, through pain, that something is wrong.  But if inflammation levels are too high, or if a person stays in an inflamed state for too long (has chronic inflammation), it can lead to disease.

What diseases are associated with unhealthy inflammation?

Many diseases are linked to inflammation.  These are often chronic (long-lasting) diseases, which can be very hard to treat.  Here are some examples:

• Alzheimer’s disease
• Asthma
• Autoimmune diseases (diseases where the body is attacked by its own immune system). These include rheumatoid arthritis, scleroderma, and lupus. 
• Cancer
• Chronic obstructive lung disease, also called COPD (emphysema and bronchitis)
• Chronic pain (e.g. back pain, neck pain, headaches, arthritis)
• Depression
• Heart disease
• Inflammatory bowel disease (Crohn’s or ulcerative colitis)
• Type 2 diabetes
• Obesity

There are many others as well.  What they all have in common is that they can often be prevented or reduced if you focus on eating some foods and not eating others.  This way of eating is often called the Anti-Inflammatory Diet.  Unlike other diets, an anti-inflammatory diet is not meant to be a diet for losing weight.  It supports your health in other ways. 

How do I eat an anti-inflammatory diet? 

It is thought that over 60% of all chronic disease could be prevented if people ate a healthy diet.  What does that diet look like?  Some of the most important parts of it are listed below.  Choose any one to start out.  Over time, you can add others at a pace that works for you. 

The Anti-Inflammatory Diet: Top Ten Suggestions

1. Pay attention to proteins. If you get most of your proteins from plants like beans, whole grains, and nuts, your levels of inflammation will be lower.  If you eat red meat, it is best to eat grass-fed meat or wild game rather than grain-fed beef.  Wild-caught (as opposed to farmed) fish can be a great source of protein.  As journalist Michael Pollan says in his book Food Rules, “The fewer the feet, the better the meat.”
2. Eat more fiber. Fiber, which is a form of carbohydrate, lowers inflammation.  Read food labels.  Different groups suggest different daily amounts, but try for the following:

• Women 19-50 years old: 25 grams daily
• Men 19-50: 38 grams daily
• Women over 50: 21 grams daily
• Men over 50: 30 grams daily

Good sources of fiber include whole grains, oatmeal, nuts, berries, beans, vegetables, brown rice, and popcorn. Potato skins have a lot of fiber.  If you don’t already eat much fiber, increase your intake of these foods slowly to avoid bowel discomfort.

1. Eat your vegetables and fruits. When it comes to ideas for healthier eating, eating more fruits and vegetables is usually at the top of the list.  In addition to their many other benefits, vegetables and fruits reduce inflammation.  Berries and cherries are especially good options.  Fruit juice is not usually a good choice because it is high in sugars and low in fiber.  Making your own smoothies is a good idea.  Choose dark colored produce that is many different colors.  Plants get their colors from phytonutrients, helpful compounds that are anti-inflammatory.   Strive for a minimum of 5 cups of vegetables and fruits per day. If you have diabetes or pre-diabetes, emphasize non-starchy vegetables over fruits.
2. Use more anti-inflammatory herbs and spices. A 2012 study found that some of the best anti-inflammatory spices to eat, in order, are paprika, rosemary, ginger, turmeric, sage, and cumin.  An earlier study looked at other chemical properties of spices and found that cloves, ground Jamaican allspice, cinnamon, sage, marjoram, and tarragon are also great choices.

Guidelines 5-8 are related to fats.  In the body, different types of fats are processed in different ways, which can either increase or decrease inflammation.

1. Avoid trans-fats.Trans-fats, which are added to foods to increase their shelf life, can add to the body’s inflammation.  Avoid foods that have labels saying they have “partially hydrogenated” oils.  Foods that often have trans-fats include baked goods (e.g. cakes, piecrusts, frozen pizza, and cookies) and fried foods (e.g. donuts, fries).
2. Limit saturated fats. Most (not all) saturated fats also promote inflammation.  These fats mostly come from animal sources such as meats (lamb, pork, chicken with skin, fatty beef), and dairy products like milk, cheese, cream, and butter. If you eat meat, a good general rule is to try to eat white meats, fish and other seafood.  Saturated fats from plants (coconut and palm kernel oils) may not be as much of a problem.
3. Balance omega-6’s and omega-3’s. You may have heard about essential fatty acids.  These are types of polyunsaturated fats that your body can’t make on its own.  You have to get them from your diet.  You need both omega-6 and omega-3fats for your body to work properly, but they need to be in the right balance.  The problem is that eating high amounts of omega-6 fats compared to omega-3’s can increase inflammation.  Unfortunately, that is exactly what most Americans do.  Our ancestors ate twice as much omega-6 fat as omega-3.  Nowadays, most Americans eat 14 to 25 times as much omega-6.

Omega-6’s come from plant oils like corn oil, soybean oil, and sunflower oil, as well as nuts and seeds. Omega-3’s are found in fatty fish like salmon, tuna, and mackerel.  Try to eat at least two servings of fish (3-4 ounces each) weekly.  Fish oil supplements are widely available.  A usual dose is 1000-2000 mg per day.  If you are taking blood thinners, talk to your doctor before you start taking fish oil.  Omega 3’s are also found in whole grains, walnuts, and green leafy vegetables.  Eating a Mediterranean diet will give you a much healthier balance of omega-6’s and omega 3’s than the average American diet.  For more information, reference the Whole Health handout “How to Eat a Mediterranean Diet.”

1. Eat monounsaturated fats. There are also monounsaturated fats.  One of these, olive oil, is known to reduce inflammation, blood pressure, bad cholesterol, and blood sugar levels.  Other sources of this type of fat are canola, peanut, safflower, and sesame oils.  Avocados are another good source.  

Some experts suggest you get ¼ of your fat from saturated fats, ¼ from polyunsaturated, and ½ from monounsaturated.  Many diets recommend that total fats add up to about ⅓ of all the calories you eat.  You have to explore what works best for you.

1. Eat some dark chocolate. Most people like this suggestion.  To help with inflammation, dark chocolate should be at least 70% cocoa mass.  The cocoa percentage will be on the label.  One and a half ounces daily decreases inflammation and also lowers blood pressure.
2. If you choose to drink alcohol, choose red wine. Red wine is known to decrease inflammation.  Of course, don’t take up drinking to get this benefit.  One study found that drinking white wine and cooking with olive oil worked together to lower inflammation as well.  Other beverages, like grape juice, have been found to have some benefits, too, though we need more studies to see how different beverages compare.  Remember, though, that even one drink of alcohol a day can increase risk of breast cancer.

Can anything besides what I eat lower inflammation?

In addition to watching what you eat and drink, focusing on other areas of self-care can also help lower inflammation.  For example:

• Working the body reduces chronic inflammation.
• Stress raises inflammation in the body, so do your best to keep your stress at a healthy level. There are many ways to manage stress, such as breathing exercises and meditation.  These are outlined in the Power of Mind handouts.
• Depression is linked to more inflammation too. Explore ways to support good mental and emotional health.
• Getting enough sleep helps to keep inflammation under control.
• Some studies show that having healthy relationships with others lowers inflammation.
• Being a spiritual/religious person also seems to be linked to less inflammation.

DASH stands for Dietary Approaches to Stop Hypertension. First introduced in 1997, it is a diet promoted by the National Institute of Health’s National Heart, Lung, and Blood Institute (NHLBI) for reducing blood pressure. Since its introduction, it has shown promise in multiple studies. In fact, various organizations have ranked it as one of the “Best Overall Diets.” This tool is designed to help you understand what exactly a DASH diet looks like, research findings related to it, and where you can go to find more information about it.

What is a DASH Diet?

Ultimately, eating according to the DASH Diet means eating a variety of foods and food groups that research has shown can be beneficial to heart health, while avoiding others, that have been found to be harmful. Key components include the following:

1. Fruits and vegetables
2. Whole grains
3. Nuts, seeds, and legumes
4. Lean protein—fish and poultry are emphasized, while red and processed meat consumption is limited
5. Low-fat or fat-free dairy
6. Avoidance of sugar-sweetened beverages
7. Low sodium—when kept under 2,300 mg daily the diet is even more helpful with blood pressure, which can drop even lower with less than 1,500 mg daily sodium intake
8. Higher levels of dietary nutrients like potassium, magnesium, calcium, and fiber
9. Lower levels of saturated fats, trans fats, and cholesterol

Note that the diet does not feature specific recommendations about alcohol intake.

Does the DASH Diet Work?

The short answer is that, yes, the DASH diet has shown a number of benefits. It lowers blood pressure (systolic and diastolic) for people with hypertension, and also for people who have blood pressures in the normal range, whether or not they lower their sodium intake. Reductions in pressures occur within one week and keep dropping if sodium restriction is ongoing.

The DASH diet has been shown to reduce the risk of sudden cardiac death on the order of approximately 13% decrease in 10-year Framingham CVD risk. It is helpful with weight loss, it lowers hsCRP levels relative to usual diets (comparably to other healthy diets), and it also offers therapeutic benefit for a wide range of other clinical conditions, including the following:

• Abnormal lipids
• Cerebrovascular disease
• Heart failure
• Colon and rectal cancer chemoprevention, and likely prevention of other cancers as well
• Insulin resistance and diabetes
• Urolithiasis (kidney stones)
• Gout
• Kidney disease

Clinical Considerations

• Ramp up fiber intake slowly, so that people can avoid becoming gassy or bloated.
• Keep food allergies and intolerances (e.g., lactose intolerance) in mind as you tailor this diet to individual needs.
• Not every healthy food is included. For example, most DASH diet guides don’t cover avocadoes. Some foods are included but may not be the best choice for their category. For example pretzels are classed as grains but don’t have a lot of fiber or nutrients.
• Different people tolerate salt restrictions differently. It may help to titrate daily amounts down gradually.
• Consider combining DASH diet recommendations with those of other diets, such as the Mediterranean Diet, which also has great evidence supporting its use.

Summary

• The DASH dietary pattern is supported by a wealth of research data
• Following DASH may result in lowered blood pressure within a week
• Long-term, a DASH eating pattern helps reduce risk for heart disease, stroke, colon cancer and insulin resistance, among other illnesses

If you have diabetes, you probably know more than most about the foods you eat and how they affect your diabetes management. While there’s no such thing as a “diabetes diet,” some people have found certain eating plans to be helpful in managing diabetes.

Healthy eating is key to managing your blood sugar. But what does it mean to eat healthy? The truth is, healthy eating looks no different for you than it does for anyone else. It includes eating foods that are lower in added sugars and saturated fat. While there’s no one-size-fits-all approach to eating healthy, several eating plans can help manage your diabetes.

The American Diabetes Association released a report reviewing several eating plans that have been shown to help people with diabetes. One of the most researched has been Mediterranean-style eating. Studies report benefits such as improved A1C levels, cholesterol, and heart health.

What Is Mediterranean-Style Eating?

Mediterranean-style eating is the traditional eating habits and lifestyle in countries along the Mediterranean Sea. More than 20 countries border the Mediterranean. Because each country differs in culture, religion, economy, and agricultural production, there’s not one specific Mediterranean way to eat. But Mediterranean eating has many common factors. These include:

• Eating plenty of fruits, vegetables, whole grains, beans, and nuts.
• Using extra virgin olive oil instead of butter or other oils.
• Limiting dairy products and red meat.
• Limiting sweets, added sugars, sodium (salt), and highly processed foods.

How Can This Way of Eating Help You Manage Diabetes?

When you have diabetes, your body doesn’t make or use insulin well and can’t keep your blood sugar at normal levels (known as insulin resistance). This causes spikes in your blood sugar and over time can lead to serious complications. Because Mediterranean-style eating is rich in plant-based foods and limits processed ones, it can help reduce insulin resistance. This leads to better blood sugar management and lower A1C levels. Mediterranean-style eating can also help:

• Improve heart health. Saturated fats and sodium are bad for your heart. They can increase cholesterol levels and blood pressure. Since heart disease is one of the most common complications of diabetes, you’ll want to limit these food with high amounts of saturated fat or sodium in your diet. Following Mediterranean-style eating can reduce your risk of heart disease and stroke.
• With weight loss, if you’re overweight. Mediterranean-style eating emphasizes foods that are full of fiber. Fiber helps with blood sugar and weight management. The Mediterranean lifestyle also encourages being physically active. Being active helps control blood sugar levels and lowers your risk of heart disease and nerve damage.
• Reduce inflammation. High blood sugar from diabetes can cause inflammation. Foods such as leafy green vegetables, fruits, olive oil, and fatty fish can help reduce inflammation and strengthen your immune system.

Choosing What’s Right for You

When choosing or creating a diabetes meal plan, it’s important to consider how different foods will affect your blood sugar and weight loss goals (if needed). Because Mediterranean-style eating limits processed foods and those high in sugar, it can help. But whether you follow this style or not, people with diabetes are advised to limit or avoid processed food.

There are things you should look out for when choosing a diabetes meal plan. For example, some eating plans can be high in carbohydrates (carbs). Mediterranean-style eating includes foods like pasta, rice, and bread, all of which can cause weight gain and spikes in your blood sugar. Fortunately, there are healthier alternatives. Instead of regular pasta you can choose whole-grain or vegetable noodles. You can also eat brown rice instead of white rice. Making these simple substitutions and paying attention to portion size can help you limit the amount of carbs you eat.

There’s no one way of eating to manage diabetes, so experiment and find what works for you. Whether it’s Mediterranean-style foods or any other, the right food plan for you will depend on your health needs, lifestyle, beliefs, taste, and culture. Work with a diabetes care and education specialist to help create yours. Working together, you can find a diabetes food plan that suits you best.

In an elimination diet, a food or group of foods is removed from a persons diet for a set period of time. This helps to determine whether specific foods or ingredients in foods contribute to symptoms. Diets are individualized based on each patients history, eating patterns, and overall symptom picture. Elimination diets are, in essence, controlled experiments that focus on changing a single dietary variable at a time.

The process of outlining and then following an elimination diet can take effort and time both for practitioners to explain and for patients to conduct. However, successfully discovering food allergies or intolerances can potentially alter the courses of several diseases and lead to profound symptom improvements.

Serum tests are available to help diagnose adverse food reactions, and these remain controversial given their low accuracy (save maybe for irritable bowel syndrome). Many of these are offered by private laboratories and focus on IgG levels. Food allergies that are IgE-mediated, however, can be accurately assessed through widely available tests. However, the gold standard for food allergies and food intolerances remain placebo-controlled food challenges.

Four key steps are involved in the process.

Step 1: The Planning Phase

Figuring Out Which Food(s) to Eliminate

Begin by ensuring that an elimination diet is clinically appropriate and something that a patient is both willing and motivated to try. A thorough dietary history, which may include a food journal, can help assure clinicians that food restrictions will not contribute to nutrient deficiencies or inappropriate weight loss.

Information to Gather if Food Intolerance Is Suspected

The following lists key points to keep in mind when taking a history from people who may have food intolerances.

• History of present illness
  • Relation of symptoms to exercise
  • Substance use (caffeine, smoking, alcohol, illicit drugs)
  • Life stressors
• Past medical history
  • Respiratory allergies
  • Chronic respiratory congestion
  • Asthma
  • Atopic dermatitis
  • Infant colic
  • Irritable bowels
  • Eating disorders
  • Food allergies
• Family history
  • Food intolerance
  • Irritable bowels
  • Headache
  • Mouth ulcers
• Lab testing
  • Previous allergy tests

Some potential risks to consider:

• Elimination diets may exacerbate an existing or activate a latent eating disorder such as anorexia or bulimia nervosa.
• Do not reintroduce foods known to provoke anaphylactic reactions.
• Be wary if one is already malnourished or is at high risk for nutritional deficiencies. This may include the elderly, autistic (given they often already restrict their diets), and those with very limited food resources.
• Given that foods also heal, be cautious of instilling a fear of food.

Consider having one keep a food-symptom diary for a few weeks as a way to better understand what foods may be leading to bothersome symptoms (Referencesample food diary). Here are some questions that often illicit problematic foods:

• What foods do you eat most often?
• What foods do you crave?
• What foods do you eat to help you feel better?
• What foods do you think you might have trouble giving up?

Why might these foods be problematic? One hypothesis is that problematic foods can both trigger an inflammatory process in the gut as well as cause endorphin release in the brain. Endorphins reduce pain, and because they lead to a sense of well-being, their release may cause continued regular consumption of triggering foods.

Once a list of potential problematic foods is generated, decide which foods to eliminate. An individualized elimination diet should be based on ones intuition (what is my gut feeling?), the answers to the above questions, and common provoking foods based on ones disease.

Table 1. Foods That Often Influence Specific Health Problems

Step 2: The Avoidance Phase

Eliminating Foods: Three Levels

The intensity of the diet depends primarily on how many foods are eliminated at a time.

Low: The simple diet eliminates milk, eggs, and wheat

Elimination of one or a few key foods. Often, these may include milk products and gluten.

• Pros: Better for people at risk of undernutrition or who might have difficulty with adherence.
• The less good: This diet plan will not help to determine if one is intolerant a broader group of foods or food combinations.

Animal proteins

Allowed: Beef, chicken, lamb, pork, turkey

Eliminated: Dairy products, chicken eggs

Grains and starches

Allowed: Arrowroot, barley, buckwheat, corn, millet, oats, rice, rye, sweet potatoes, tapioca, white potatoes, yams

Eliminated: Dairy-based butter and margarines

All fruits, vegetables, salt, spices, sweeteners, and vegetable proteins are allowed.

Moderate: A stricter diet that eliminates several food groups

Pros: High rates of success in determining all kinds of food intolerances without significant nutritional risks.

Cons: Requires significant planning, recording, and time.

Animal proteins

Allowed: Lamb

Eliminated: All others, including eggs and milk

Vegetable proteins

Allowed: None

Eliminated: Beans, bean sprouts, lentils, peanuts, peas, soy, all other nuts

Grains and starches

Allowed: Arrowroot, buckwheat, corn, rice, sweet potatoes, tapioca, white potatoes, yams

Eliminated: Barley, millet, oats, rye, wheat

Vegetables

Allowed: Most

Eliminated: Peas, tomatoes

Fruits

Allowed: Most

Eliminated: No citrus or strawberries

Sweeteners

Allowed: Cane or beet sugar, maple syrup, corn syrup

Eliminated: Any others, including aspartame

Oils

Allowed: Coconut, olive, safflower, sesame

Eliminated: Animal fats (lard), butter, corn, margarine, shortening, soy, peanut, other vegetable oils

Other

Allowed: Salt, pepper, a minimal number of spices, vanilla, lemon extract

Eliminated: Chocolate, coffee, tea, colas and other soft drinks, alcohol

High: A few-foods diets eliminates of all but a few foods

This might be used if one has a long list of potential intolerances and wants to wipe the slate clean.

• Pros: Highest chance for symptom improvement.
• Cons: Greatest potential risks for malnutrition or orthorexia (a fear of food). Requires significant time for the reintroduction process (Reference Step 3: The Challenging Phase, below).

Only the foods listed below are allowed.

• Apples (juice okay)
• Apricots
• Asparagus
• Beets
• Cane or beet sugar
• Carrots
• Chicken
• Cranberries
• Honey
• Lamb

• Lettuce
• Olive oil
• Peaches
• Pears
• Pineapple
• Rice (including rice cakes and cereal)
• Safflower oil
• Salt
• Sweet potatoes
• White vinegar

Table 2. Another Challenge: How to Know Which Foods to Avoid

Step 3: The Challenging Phase

Reintroducing the Eliminated Foods

Rule of 3s:

• 3 weeks of elimination,
• then challenge during all 3 meals of 1 day,
• then wait 3 days before another rechallenge.

Symptoms will often worsen for a few days before they improve.

Given the subtleties of how food intolerances manifest, eliminating a food is not enough to determine if it might be a problem. Reintroducing the food will provide yet another way to assess an association between foods and symptoms, given the waxing and waning course of most diseases. On the single day of a food or food groups reintroduction, one should eat increasing quantities with each meal. Starting low is important, in case a serious adverse reaction occurs with an exposure to even a small amount of food. Because it can take several days for symptoms to reappear, a 3-day waiting period after reintroduction is recommended. Regardless of what occurs, that food should then be eliminated again. A new food is reintroduced, and the cycle starts again. The section below summarizes the timing for a typical elimination diet process.

Elimination Diet Timing

Begin Elimination Diet

• Week 1: Symptoms may worsen
• Week 2 and 3: Symptoms may improve
• Reintroduction Day (Food #1): Reintroduce one eliminated food, in increasing amounts, at all three meals for just 1 day
• Watching and waiting for 3 days: Symptoms may worsen or not; then continue to eliminate selected food after 1-day reintroduction
• Reintroduction Day (Food #2): Reintroduce a different eliminated food, in increasing amounts, at all three meals for just 1 day
• Watching and waiting for 3 days: Symptoms may worsen or not; then continue to eliminate selected food after 1-day reintroduction
• Reintroduction Day (Food #3): Reintroduce a different eliminated food, in increasing amounts, at all three meals for just 1 day

and the cycle continues until all foods have been evaluated

Step 4: The Maintenance Phase

THE BEGINNING OF A NEW DIET (AND A BETTER LIFE!)

After the elimination diet has been completed, a new diet should emerge that removes specific foods or food groups long term. If it is not found to be beneficial, another elimination diet could be instituted at a later time.

If one is avoiding specific food groups that are associated with higher levels of specific vitamins or nutrients, other foods that are tolerated might need to be eaten in higher amounts to make up for these deficits (e.g. increasing leafy green intake if one is avoiding dairy foods). Dieticians can be valuable team members for assisting with these issues.

Foods that cause an IgE-mediated food allergy should NOT be reintroduced.

Given that the removal of problematic foods or food groups can allow the body to heal, one may be able to reintroduce eliminated foods (using the every-3-days process described above) in 3-12 months. In this way, elimination diets not only may alleviatesymptoms but also may treat disease. Ideally, the clinician will work with the patient to improve the ecosystem of the GI tract, reduce intestinal permeability, and enhance tolerance so that formerly problematic foods can eventually be reintroduced.

If you have celiac disease, removing gluten from your diet will control symptoms, heal existing damage to the small intestine, and prevent further damage over time.

A gluten-free diet means not eating foods that contain gluten, a protein found in wheat, barley, and rye. If you have celiac disease, removing gluten from your diet will control symptoms, heal existing damage to the small intestine, and prevent further damage over time.

Your doctor may suggest that you work with a dietitian to create a gluten-free diet plan. The dietitian can help you understand how to read food labels and identify gluten-containing foods at the grocery store or eating out.

The good news is that there are many healthy, gluten-free foods available, and most people recover completely on a gluten-free diet.

Is time-restricted eating right for you?

Intermittent fasting has gotten a lot of attention recently—everyone from celebrities to social media influencers is talking about it.

The idea is that by limiting the time during the day when you can eat, you can lower your calorie intake and maybe lose weight. But does it actually work? Is it healthy? We answer these questions and more in a roundup from the National Institutes of Health (NIH).

What is intermittent fasting?

Also called time-restricted feeding, intermittent fasting is when people restrict the time during the day when they can eat. For example, someone may eat only during a 12-hour time period, such as 7 a.m. to 7 p.m.

Can it help you lose weight?

Many people choose intermittent fasting as a way to lose weight. And some early NIH research supports this, says Charlotte Pratt, Ph.D., RD, of the National Heart, Lung, and Blood Institute. "In studies, people were able to demonstrate some changes in terms of body weight following a time-restricted eating plan," Dr. Pratt explains. Research in animals has shown that calorie reduction can slow down aging and prevent some diseases. However, more research needs to be done in humans before the health benefits—and risks—are fully understood.

Does what you eat when fasting matter?

The timing of meals should not be the only factor in trying to lose weight or becoming healthier, Dr. Pratt notes. What and how much you eat are also important. Current U.S. dietary guidelines recommend eating a diet rich in fruits, vegetables, and whole grains. Dr. Pratt says that most adults should also do at least 150 to 300 minutes (2 1/2 to 5 hours) a week of moderate-intensity, preferably aerobic activity that is spread throughout the week.

Is it safe?

It is not safe for everyone, especially those with health conditions like diabetes, kidney disease, or heart-related issues. "Intermittent fasting should be approached individually and with the help of a dietitian or physician," Dr. Pratt says. As with all diets, you should talk with your doctor or other health care provider before you try it. Your provider can review your health history and medication list and help you decide which eating plan and exercise schedule is best for you.

What future research is NIH planning to do?

One NIH clinical trial that is currently recruiting participants focuses on the effects of intermittent fasting on nonalcoholic fatty liver disease. Participants will be allowed to eat a set number of calories between 8 a.m. and 4 p.m. every day. Throughout the study, researchers will look for changes in certain fat levels, body weight, and other health indicators.

Another NIH-supported clinical trial will study whether time-restricted feeding can help improve insulin resistance and reduce weight in women with polycystic ovary syndrome, or PCOS. Dr. Pratt notes that this study will take place over 16 weeks and is expected to be completed at the end of 2021.

What is FODMaP?

The FODMaP diet is a form of elimination diet that focuses specifically on foods that contain specific types of fermentable sugars. FODMaP is an acronym built on the names of the 5 classes of sugars that are eliminated (Figure 1). Increasing numbers of studies support its use for reducing symptoms of irritable bowel syndrome (IBS). However, most of these studies were short-term (less than 6 weeks), utilized dietitians with specialized training, and did not conclusively show that following this diet is more effective than other general dietary advice (e.g., decreasing alcohol, changing the amount of fat in the diet, or increasing dietary fiber). That said, the FODMaP diet plan can serve as a framework for an elimination diet that can be individualized, especially if more general elimination diet approaches prove unhelpful.

The Low FODMaP diet works in two ways:

1. It is low in sugars that can be difficult to absorb. These sugars can lead to increased fermentation and gas.
2. Reducing overall sugar intake reduces the osmotic pull of fluids into the intestine, which can reduce diarrhea. This may explain why some research indicates that the FODMaP diet improves pain and boating symptoms by up to 75%, predominately in those with IBS associated with diarrhea.

The Modified Low FODMaP Diet

The Low FODMaP diet can lead to a significantly lowered intake of fiber from fruits and vegetables, which could lead to micronutrient deficiencies and adversely affect the microbiome. Although it has not been extensively studied, some people may benefit from a modified FODMaP diet, which prevents these reductions in nutrients by allowing for continued intake of some higher FODMaP foods. This eating approach begins with having patients avoid dairy, wheat, rye, high-fructose corn syrup, honey, and polyol sugars (first row of Figure 2). If this doesnt work after a trial of a few weeks, they can then do the full FODMaP diet, as outlined in Figure 2.

What is Sodium?

Sodium is a mineral found naturally in small amounts in foods such as meat, dairy, poultry, and vegetables. Most of the sodium we eat is in the form of sodium chloride (salt).

Sodium plays many important roles for the human body to function properly. Eating too much sodium raises blood pressure, increases the risk of stroke, reduces the effect of some medicines, and causes fluid to build up in the body. Fluid buildup in your body can further cause damage by making your heart, liver and kidneys work harder.

Your body only needs a little amount of sodium daily. Foods don’t have to taste salty to have sodium in them. It is possible to eat too much sodium even without use of a saltshaker. Over 75% of sodium comes from processed and restaurant foods. 11% comes from salt added to food when cooking or eating. Examples of high-sodium foods are:

• All forms of salt (table salt, sea salt, seasoning salt)
• Processed foods: canned items, lunch meats, frozen foods, cheese
• Snack foods: vegetable juices, chips, granola bars, popcorn
• Condiments/Sauces: ketchup, mayonnaise, barbeque sauce, soy sauce, teriyaki sauce, tartar sauce, salad dressings, cheese sauces, gravy

A low sodium diet limits salt to 1,500-2,000 milligrams (mg) per day or less than 1 teaspoon (tsp) per day.

Salt preference is an acquired taste that can be unlearned. In about 6- 8 weeks your taste buds will adjust to lower sodium eating and high sodium foods you used to enjoy may be way too salty to your liking.

Tips to Reduce Sodium Intake:

When Shopping: Use the Nutrition Facts Food Label. Shop Smart:

• When reading a Nutrition Facts label, look at the sodium content.
• Choose foods with 140 mg sodium or less per serving.
• Avoid food with more than 300 mg of sodium per serving.
• Check the serving size on the Nutrition Facts Label. The amount of sodium listed on the label is per serving not for total servings found in packaged item. Some Nutrition Facts Labels may also indicate the total amount of sodium in the package.
• Use % Daily Value (% DV) of sodium on food labels to help you quickly compare brands or products.
• Choose foods with 5% or less Daily Value sodium, these are low sodium.
• Avoid foods with 20% or higher Daily Value sodium, these are high sodium.
• Claims on food labels about sodium can help guide you.
• Products that state salt-free, sodium-free, low sodium and very low sodium have less than 140 mg per serving.
• Products that have the words unsalted, no salt added, reduced sodium or lower sodium may still be high in sodium.
• Read ingredient lists.
• Labels list the ingredients in order with those that weigh the most appearing first and those that weigh the least appearing last.
• Choose foods where sodium is listed near the end of the list. Look for ingredients that contain sodium: saline, sodium benzoate, sodium bicarbonate (baking soda), sodium chloride (salt), sodium nitrate, and monosodium glutamate (MSG).
• Check the fine print on packaging. Look for words like “broth”, “saline” or “sodium solution”.

Choose Fresh Foods:

• Cook from scratch if you can.
• Control sodium intake by using fresh or frozen fruit and vegetables.
• Fresh meats, chicken, and fish are lower in sodium than processed, canned, lunch, cured or smoked meats such as sausage, bacon, ham, brats and or hotdogs.
• Choose meats without added salt water or saline.

When Preparing/Cooking Foods:

• Enhance the natural flavor of foods by adding onions, garlic, herbs, spices, citrus fruits or citrus juices, and vinegars in place of some or all the salt.
• Make your own salt-free seasoning blend at home.
• Avoid seasonings that contain the word salt like onion salt and garlic salt.
• Choose onions or garlic powder and sodium-free herbs blends.
• Roast, sear, sauté, braise and grill to bring out the natural flavors of foods
• Drain and rinse canned foods such as beans, tuna, and vegetables in a strainer and cook them in fresh water (instead of the canned fluid) to remove some excess sodium.

When Eating at Restaurants:

• Choose carefully. Restaurant foods can be high in sodium.
• Ask if your food can be prepared without the extra salt.
• Taste your foods before adding salt. If not flavorful enough trying adding pepper or lemon juice before adding table salt.
• Look for words like pickled, smoked, cured, au jus, soy sauce, miso or Teriyaki sauce. These words indicate foods with high in salt.
• Asked for salad dressing and sauces to be served on the side.
• Control your portion size. A smaller portion= less sodium. Take the rest home.
• Look for Nutrition facts at the restaurant’s website or ask if there is more information available at the restaurant.

Ask before using a salt substitute:

• Salt substitutes that look and taste like salt usually contain high amounts of potassium. Too much potassium can cause serious problems for those with certain medical conditions or those taking certain medications. Check with your doctor or dietitian before using a salt substitute.

A vegetarian diet focuses on plants for food. These include fruits, vegetables, dried beans and peas, grains, seeds and nuts. There is no single type of vegetarian diet. Instead, vegetarian eating patterns usually fall into the following groups:

• The vegan diet, which excludes all meat and animal products
• The lacto vegetarian diet, which includes plant foods plus dairy products
• The lacto-ovo vegetarian diet, which includes both dairy products and eggs

People who follow vegetarian diets can get all the nutrients they need. However, they must be careful to eat a wide variety of foods to meet their nutritional needs. Nutrients vegetarians may need to focus on include protein, iron, calcium, zinc and vitamin B12.

You can enjoy your meals while making small shifts to the amounts and types of food on your plate. Healthy meals start with a variety and balance of foods from each food group. Aim to consume less sodium, saturated fat, and added sugars.

1. Get to know the foods you eat

Keep track of the food and beverages you consume by using SuperTracker. This tool gives you tips on how to make healthier food choices.

2. Take your time

Be mindful to eat slowly, enjoy the taste and textures, and pay attention to how you feel. Use hunger and fullness cues to recognize when to eat and when you’ve had enough.

3. Use a smaller plate

Use a smaller plate at meals to help with portion control. That way you can finish your entire plate and feel satisfied without overeating.

4. If you eat out, choose healthier options

Many restaurants have nutrition information posted online or on menus. Choose entrees that are baked or broiled instead of fried. Ask for dressings or sauces on the side.

5. Satisfy your sweet tooth in a healthy way

Indulge in a naturally sweet dessert dish—fruit! Mix berries with fat-free yogurt or enjoy fruit on its own, such as melon or pineapple

6. Choose to eat some foods more or less often

Eat more vegetables, fruits, whole grains, and low-fat dairy products. Cut back on foods such as pizza, ice cream, cookies, and cake.

7. Create your own meal plan

Plan out your meals in advance. Use Sample Meal Plans on SuperTracker for ideas to plan healthy meals.

8. Sip smarter

Drink water or other calorie-free beverages, such as unsweetened tea or club soda, or other low-calorie beverages when you are thirsty. Sugar-sweetened beverages contain added sugar and are high in calories.

9. Compare foods

Check out the Food-A-Pedia to look up and compare nutrition information for more than 8,000 foods.

10. Make sweets a once-in-a-while treat

Treat yourself on special occasions. When you eat foods like pie, cake, brownies, cookies, and candy, choose the smallest size or consider sharing it.

What’s the eating style that’s best for health? Is it a Mediterranean eating plan? Vegetarian? Low carb? With all the eating styles out there, it’s hard to know which one to follow.

Healthy eating is one of the best ways to prevent or delay health problems. Eating well, along with getting enough physical activity, can help you lower your risk of health problems like heart disease, diabetes, obesity, and more. To reach your goals, experts advise making small, gradual changes.

“The best diet to follow is one that is science based, that allows you to meet your nutritional requirements, and that you can stick to in the long run,” says Dr. Holly Nicastro, an NIH nutrition research expert. “It’s not going to do you any good to follow a diet that has you eating things that you don’t like.”

The main source of science-based nutrition advice is the Dietary Guidelines for Americans. These guidelines describe which nutrients you need and how much. They also point out which ones to limit or avoid.

“Every five years an expert panel reviews all available scientific evidence regarding nutrition and health and uses that to develop the dietary guidelines,” Nicastro explains.

The guidelines are regularly updated because our scientific understanding of what’s healthy is continuously evolving. These changes can be confusing, but the key recommendations have been consistent over time. In general, healthy eating means getting a variety of foods, limiting certain kinds of carbs and fats, watching out for salt, and being aware of your portion sizes.

Limit Added Sugars

Added sugar is the extra sugar added to foods and drinks during preparation. Corn syrup, high-fructose corn syrup, brown sugar, and honey are examples of sweeteners added to foods and drinks, especially regular sodas.

“The sugars present normally in milk and fruit are not considered added sugar,” explains Dr. Kimber Stanhope, a nutrition researcher at the University of California, Davis.

Stanhope’s research focuses on the effects of added sugar on the development of disease. Her studies have shown that consuming too much high-fructose corn syrup may increase the risk of weight gain and heart disease.

The Dietary Guidelines for Americans suggest a daily limit on added sugar of no more than 10% of calories. That’s about the amount in 16 ounces of regular soda (190 calories). You can find information about added sugars on most Nutrition Facts labels now.

“Anybody can improve their diet by substituting fruits and vegetables for sugar as their snacks, as part of their dessert, and as part of their meals,” says Stanhope. “There are no advantages of consuming added sugar.”

Consider Your Fats

Fat is high in calories and can increase your chances of developing obesity, heart disease, and other health problems. But there are different kinds of fats.

Fats that are liquid at room temperature, or oils, are considered to be healthier than those that are solid. Solid fats are found in high amounts in beef, chicken, pork, cheese, butter, and whole milk. Solid fats have more saturated fats than liquid oils. Liquid oils—such as canola, corn, olive, or peanut oil—have mostly unsaturated or polyunsaturated fats.

The dietary guidelines encourage consuming liquid oils rather than solid fats. Nicastro advises that you examine the fat content on the Nutrition Facts label. The label shows how much saturated fat a product contains. Experts suggest that you aim for getting less than 10% of your calories from saturated fats.

“For the average person, that’s going to be less than 20 grams of saturated fat per day,” Nicastro says.

For example, a small cheeseburger may have 5 grams of saturated fat, a typical cheeseburger may have 13, and a double cheeseburger with bacon may have 24!

Check Labels for Salt

The Nutrition Facts label also shows salt, or sodium. Experts advise you to limit salt, which tends to be very high in processed foods.

If you eat salty, highly processed food, you can quickly go over the daily limit of one teaspoon of salt (2,300 milligrams of sodium). Two hot dogs might have 900 milligrams of sodium. A can of ravioli might have 1400 milligrams. Other examples of salty, highly processed foods are bacon, frozen pizzas, and salad dressings.

Along with a lot of added salt, processed foods might have preservatives, sweeteners, and other substances added during preparation.

“Stuff that comes in a box or a bag that has a whole lot of different ingredients—many of which you can’t read and understand or pronounce—those things are highly processed and generally bad for your health,” explains Dr. David C. Goff, Jr., a public health expert at NIH.

Make a Meal Plan

“Figuring out what to eat is less than half the battle,” Nicastro says. “Sticking to your plan is a bigger challenge. So that’s why it helps to be really prepared and plan ahead.”

You’re much more likely to stick to your meal plan if you have healthy food that is ready to go. Some people find it helpful to prepare meals for the week in advance so that healthy food is within reach.

The DASH eating plan is a good start. DASH was developed by NIH-supported research to help people lower blood pressure without medicine, but it’s for anyone. Studies have shown that it reduces the risk of many diseases.

“The DASH diet is very flexible because you can follow DASH without going to a specialty grocery store. You can follow it with items that are very familiar to most people in this country,” Nicastro says.

The DASH eating plan is rich in fruits, vegetables, whole grains, beans, seeds, nuts, and fish. Compared to the typical American diet, it’s lower in salt, added sugars, fats, and red meat. It’s also higher in fiber, potassium, magnesium, and calcium than the typical American diet.

“Anybody can follow it, despite specific preferences or culture,” Nicastro says. It even works for people who are vegetarian or only eat Kosher foods.

Get Expert Advice

The Dietary Guidelines for Americans are designed to help people avoid developing obesity, diabetes, and heart disease. But everyone is different. You may have needs and risks that aren’t like the average American. Talk to your health care provider about your unique nutritional needs.

“A great resource for someone to help you with your diet is a registered dietitian nutritionist, or RDN,” Nicastro says.

Make Healthy Diet Choices

• Eat a variety of foods—vegetables, fruits, whole grains, beans, nuts, seeds, lean meat, seafood, eggs, milk, yogurt, and cheese.
• Limit foods that are low in vitamins and minerals.
• Avoid foods with added sugar.
• Replace foods containing saturated fats(like butter or lard) with healthier unsaturated fat options.
• Watch out for foods high in salt.

Eating healthy isn’t always easy. Expert-recommended diets often emphasize fresh, whole foods and home-cooked meals. But that can be expensive and time-consuming. Highly processed foods are often cheap and convenient. But they also tend to be high in calories, added sugar, saturated fat, and salt, and low in fiber.

Scientists are starting to learn that highly processed foods can have certain effects on your body that may make sticking to your healthy eating goals even harder. Eating too much of them may lead to weight gain and increase your risk for certain diseases, like cancer, diabetes, and obesity.

What Are Ultra-Processed Foods?

Most foods that we eat are processed to some extent—they’re modified from how they exist in nature. Chopping, grinding, drying, cooking, and freezing are all forms of food processing. Some forms of processing are good for your health. For example, cooking meat and pasteurizing milk can help prevent foodborne diseases. But if your food is processed too much, it may be harmful to your health.

Ultra-processed foods are those that have undergone the greatest level of processing. As a general rule, ultra-processed foods are those that have been made using additives, ingredients that you wouldn’t likely have in your home kitchen. These include things like hydrogenated oils, isolated proteins, and high-fructose corn syrup. Ultra-processed foods are often made using industrial processes that you can’t easily do at home.

“If you’re standing in the grocery store, in one of the middle aisles, and the thing that you’re holding is in a crinkly package, you’re probably holding an ultra-processed food,” says Dr. Alexandra DiFeliceantonio, a neuroscientist who studies health behaviors at Virginia Tech.

Ultra-processed foods are designed to be low cost and have long shelf lives. They’re tasty, convenient, and ready to eat. Examples include carbonated soft drinks, chips, chicken nuggets, and sausages. Having too much of these in your diet may result in overeating and can be harmful to your health.

Understanding Overeating

It’s difficult for scientists to study exactly how ultra-processed foods affect overeating. That requires carefully controlling people’s diets for weeks at a time.

But NIH metabolism researcher Dr. Kevin Hall has done just that. In a recent study, he compared calorie intake and weight gain in participants who ate a highly processed diet with those who ate a minimally processed diet. Study participants stayed at NIH’s Metabolic Clinical Research Unit for four weeks, spending two weeks on each diet. Both diets offered the same amount of calories, sugar, fiber, fat, sodium, and carbohydrates on a daily basis. Participants could eat as much or as little as they wanted.

When people were on the diet with ultra-processed foods, they ate about 500 more calories each day. They also gained about 2 pounds on average. In contrast, when they were on the less-processed diet, they lost about 2 pounds.

The differences weren’t due to different nutrients in the overall diet. And, the participants rated the meals on both diets as equally pleasant. So why did people eat more of the diet filled with ultra-processed foods? The researchers aren’t sure.

Hall’s team is now looking at what else might be in ultra-processed foods that leads people to overeat. The brain may react differently to those foods, he says, or the gut may send out different signals after they’re digested.

The tendency for ultra-processed foods to lead to overeating may partly explain the recent rise in obesity. “But we rely on ultra-processed foods too much to get rid of them,” Hall says. “They’re tasty, they’re convenient, and it doesn’t take much time or effort or skill to prepare them.”

Hall hopes that a better understanding of what’s causing increased calorie consumption can help guide how such foods are made, or which ones people choose to eat.

“If we had ways to target problematic foods by understanding how they cause overeating, that might help manufacturers reformulate those foods so that they no longer cause problems,” says Hall. “Or it might help policymakers come up with ways to regulate potentially problematic foods.”

Changing the Brain

One way that ultra-processed foods might lead to overeating is by altering the brain. DiFeliceantonio’s team is using MRI scans to see how ultra-processed foods affect the brain’s reward system. These are the parts of the brain that are activated by pleasure and drive us to seek it out. DiFeliceantonio is studying whether a diet high in ultra-processed foods affect this system, and if the changes lead to people eating more when they’re not hungry.

If consuming ultra-processed foods and drinks might make you want more, does that mean you can get addicted to them? Right now, it’s not clear whether ultra-processed foods are addictive. But some studies suggest they might be.

“These ultra-processed, highly rewarding foods have way more in common with a cigarette than they do with an apple or an orange or black beans,” says Dr. Ashley Gearhardt, a clinical psychologist who studies overeating behaviors at the University of Michigan. “Some of the same brain circuitry turns on when we’re craving drugs as when we’re craving these ultra-processed foods.”

Gearhardt says that eating ultra-processed foods may lead to a compulsive habit. This means you have difficulty cutting back even when you want to. This is similar to what happens with addictive substances.

Addictive substances can also cause withdrawal symptoms when you stop taking them. Symptoms can include irritability, agitation, depression, and strong cravings for the substance. Gearhardt and others are studying whether cutting back on ultra-processed foods can cause similar withdrawal symptoms. This research may help explain why eating healthier can be harder for some people.

“Right now, we tell people they should feel better if they’re eating healthier,” Gearhardt says. “But we hear a lot of people say: ‘When I start to eat healthier, I feel so irritable and agitated. My cravings are so strong that I don’t feel better. I feel worse.’”

If we recognize that these symptoms can occur, we could give people strategies to manage them, says Gearhardt. That might make it easier for people to change their eating habits.

Eating Healthier

• Choose whole foods whenever possible. These include fruits and vegetables, unprocessed meat and seafood, and nuts and legumes.
• Drink fewer sugar-sweetened beverages, such as soda and sports drinks.
• Choose foods made from whole grains rather than refined grains. For example, eat whole grain bread or pasta and brown rice instead of white bread, pasta, or rice.
• Keep healthy snacks on hand, like vegetables and hummus, fruit, low-fat yogurt, nuts, and seeds. That can make it easier to choose healthy foods when you’re hungry.
• Read nutrition labels. Choose nutrient-rich products with simple ingredients. Limit those that are high in sugar and salt.
• Seek support. Get help from your family and friends. Consider consulting a dietitian.