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Eat, Drink, and Be Healthy: The Harvard Medical School Guide to Healthy Eating

Eat, Drink, and Be Healthy: The Harvard Medical School Guide to Healthy Eating “Eat, Drink, and Be Healthy”: Is this just another book with a catchy title telling us what to eat? The public is inundated with these tomes promising us the “truth” about nutrition and health. At best, the vast majority of these works are naive and proselytizing; at worst, they are disingenuous and deceitful manipulations of science. So, what does Dr. Walter Willett's book have in common with these other works? Absolutely nothing. Here is one of the few books on nutrition and health written for the lay public that is based on a careful and thoughtful analysis of (of all things) science! Nothing is particularly new or unusual about this book—and that is its strength. Willett says at the beginning of chapter 3, “My aim in this book is to offer straightforward, no-nonsense advice on nutrition based on the best information available” (1, p. 35). The book is approximately 300 pages in length and divided into 12 chapters, each clearly written and respectful of the reader's intelligence but careful to define scientific jargon. The introduction and the first two chapters explain the purpose of the book and give the reader the groundwork necessary to understand Willett's arguments. Chapters 3–11 specifically address the elements of his arguments. The 12th chapter, nearly one third of the book, is devoted to recipes. In the book's preface, Willett states that his intent is to “share with you what my colleagues and I have learned about the long-term effects of diet on health.” By and large, he does just this. He educates the reader about how we know what we know with a gentle diversion into methods of inquiry: randomized trials, cohort studies, case-control studies, and metabolic studies. Most of his conclusions are based on published data from major investigations such as the Nurses' Health Study, the Physicians' Health Study, and the Health Professionals Follow-up Study. Armed with this information, he takes on an icon of the establishment: the US Department of Agriculture (USDA) Food Guide Pyramid (2). The Pyramid, according to Willett, represents the views of an amalgam of special interests molded together in the cauldron of the Department of Agriculture. Why the USDA, an agency responsible for promoting American agriculture, has ultimate authority over what many consider the single most important tool for improving the nation's health is not addressed; but setting politics aside, Willett minces no words about the problems with the current Pyramid: “At best, the USDA Pyramid offers wishy-washy, scientifically unfounded advice on an absolutely vital topic—what to eat. At worst, the misinformation contributes to overweight, poor health, and unnecessary early deaths. In either case, it stands as a missed opportunity to improve the health of millions of people” (1, p. 16). From the ashes of the USDA Pyramid arises the phoenix of Willett's new pyramid. There are seven fundamental principles: “watch your weight,” “eat fewer bad fats and more good fats,” “eat fewer refined-grain carbohydrates and more whole-grain carbohydrates,” “choose healthier sources of proteins,” “eat plenty of vegetables and fruits, but hold the potatoes,” “use alcohol in moderation,” and “take a multivitamin for insurance.” There is nothing terribly radical here. All in all, Willett's arguments are thoughtful, logical, concise, and supported by scientific evidence; but what does he have against potatoes? One medium-sized baked potato with skin has just 200 calories and is virtually fat-free. Potatoes are a good source of fiber, iron, phosphorus, vitamin B6, and niacin, and a fair source of vitamin C. They are an excellent source of potassium; in fact, half of a large baked potato with skin contains more potassium than a 6-ounce (18-dl) glass of orange juice. Willett, usually the ever-critical scientist, seems to have lost his edge on this one. His argument is based on the “glycemic index” hypothesis (3). It has been known for a long time that some foods contain readily absorbable sugars that lead to a rapid rise and subsequent fall in serum insulin levels (high-glycemic-index foods). It is this sudden “stress” on the islet cells of the pancreas (or something else not yet understood) that may be a contributing factor in the development of type 2 diabetes mellitus. Studies of skinless potatoes fed to subjects who have fasted overnight (1, p. 93) do show a sudden rise in insulin levels (i.e., the potatoes have a high glycemic index), but a person rarely sits down and eats just potatoes on an empty stomach. For the glycemic index of potatoes to be helpful, insulin levels must be measured when the potatoes have been consumed along with a meal—something that has not been sufficiently studied. There is an important omission in this book. Obesity, hypertension, and diabetes mellitus are epidemic in our society, but they are especially rampant in the lower socioeconomic groups. There are a myriad of reasons for this, but diet is certainly an important one. From a public health perspective, improving the nutrition of this group of people would give us the greatest “bang for the buck.” It would have been nice to see more of Willett's creative energy focused on this aspect of the problem. A couple of other quibbles: Willett advocates taking a multivitamin “for insurance.” Here he departs from recommendations based on research “gleaned from studies that have tracked hundreds of thousands of people for over 20 years” (to quote from the book's jacket) and resorts to personal opinion. (We cannot be too hard on him for this conclusion: Our own UC Berkeley Wellness Letter also advocates a daily multivitamin, but only for older people.) Another: In Willett's introductory chapter, hyperbole may get the better of him when he claims that “a healthy diet teamed up with regular exercise and no smoking can eliminate 80 percent of heart disease and 70 percent of some cancers” (1, p. 15). Willett himself warns us about taking it all too seriously by quoting Mark Twain: “Be careful about reading health books. You may die of a misprint.” Given the caveats mentioned above, one need not “be careful about reading” this book. It is not the long-awaited Holy Grail of human nutrition, and it certainly does not claim to be. What it is, however, is a thoughtful assessment based primarily on epidemiologic studies. Furthermore, it provides, as Willett claims, “a solid sense of state-of-the-art healthy eating today.” Subjecting the discipline of medicine to the rigors of scientific investigation (the catch-phrase today is “evidence-based medicine”) has led us out of many centuries of darkness. Walter Willett is to be congratulated for doing this with nutritional science. Over the next decade, many more studies on nutrition and health will bring forth fruit. We can only hope that Walter Willett will be around to communicate this information to the public. By Walter C. Willett ISBN 0-684-863375, Simon and Schuster, New York, New York (Telephone: 800-223-2336, Fax: 800-943-9831, World Wide Web: www.simonandschuster.com), 2001, 304 pp., Hardcover $25.00 REFERENCES 1. Willett WC. Eat, drink, and be healthy: the Harvard Medical School guide to healthy eating. New York, NY: Simon and Schuster, 2001. Google Scholar 2. Food and Nutrition Information Center, National Agricultural Library, US Department of Agriculture. The Food Guide Pyramid. Beltsville, MD: US Department of Agriculture, 2000. (www.pueblo.gsa.gov/cic_text/food/food-pyramid/main.htm). Google Scholar 3. Jenkins DJ, Wolever TM, Taylor RH, et al. Glycemic index of foods: a physiological basis for carbohydrate exchange. Am J Clin Nutr  1981; 34: 362–6. Google Scholar http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Epidemiology Oxford University Press

Eat, Drink, and Be Healthy: The Harvard Medical School Guide to Healthy Eating

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Publisher
Oxford University Press
ISSN
0002-9262
eISSN
1476-6256
DOI
10.1093/aje/154.12.1160-a
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Abstract

“Eat, Drink, and Be Healthy”: Is this just another book with a catchy title telling us what to eat? The public is inundated with these tomes promising us the “truth” about nutrition and health. At best, the vast majority of these works are naive and proselytizing; at worst, they are disingenuous and deceitful manipulations of science. So, what does Dr. Walter Willett's book have in common with these other works? Absolutely nothing. Here is one of the few books on nutrition and health written for the lay public that is based on a careful and thoughtful analysis of (of all things) science! Nothing is particularly new or unusual about this book—and that is its strength. Willett says at the beginning of chapter 3, “My aim in this book is to offer straightforward, no-nonsense advice on nutrition based on the best information available” (1, p. 35). The book is approximately 300 pages in length and divided into 12 chapters, each clearly written and respectful of the reader's intelligence but careful to define scientific jargon. The introduction and the first two chapters explain the purpose of the book and give the reader the groundwork necessary to understand Willett's arguments. Chapters 3–11 specifically address the elements of his arguments. The 12th chapter, nearly one third of the book, is devoted to recipes. In the book's preface, Willett states that his intent is to “share with you what my colleagues and I have learned about the long-term effects of diet on health.” By and large, he does just this. He educates the reader about how we know what we know with a gentle diversion into methods of inquiry: randomized trials, cohort studies, case-control studies, and metabolic studies. Most of his conclusions are based on published data from major investigations such as the Nurses' Health Study, the Physicians' Health Study, and the Health Professionals Follow-up Study. Armed with this information, he takes on an icon of the establishment: the US Department of Agriculture (USDA) Food Guide Pyramid (2). The Pyramid, according to Willett, represents the views of an amalgam of special interests molded together in the cauldron of the Department of Agriculture. Why the USDA, an agency responsible for promoting American agriculture, has ultimate authority over what many consider the single most important tool for improving the nation's health is not addressed; but setting politics aside, Willett minces no words about the problems with the current Pyramid: “At best, the USDA Pyramid offers wishy-washy, scientifically unfounded advice on an absolutely vital topic—what to eat. At worst, the misinformation contributes to overweight, poor health, and unnecessary early deaths. In either case, it stands as a missed opportunity to improve the health of millions of people” (1, p. 16). From the ashes of the USDA Pyramid arises the phoenix of Willett's new pyramid. There are seven fundamental principles: “watch your weight,” “eat fewer bad fats and more good fats,” “eat fewer refined-grain carbohydrates and more whole-grain carbohydrates,” “choose healthier sources of proteins,” “eat plenty of vegetables and fruits, but hold the potatoes,” “use alcohol in moderation,” and “take a multivitamin for insurance.” There is nothing terribly radical here. All in all, Willett's arguments are thoughtful, logical, concise, and supported by scientific evidence; but what does he have against potatoes? One medium-sized baked potato with skin has just 200 calories and is virtually fat-free. Potatoes are a good source of fiber, iron, phosphorus, vitamin B6, and niacin, and a fair source of vitamin C. They are an excellent source of potassium; in fact, half of a large baked potato with skin contains more potassium than a 6-ounce (18-dl) glass of orange juice. Willett, usually the ever-critical scientist, seems to have lost his edge on this one. His argument is based on the “glycemic index” hypothesis (3). It has been known for a long time that some foods contain readily absorbable sugars that lead to a rapid rise and subsequent fall in serum insulin levels (high-glycemic-index foods). It is this sudden “stress” on the islet cells of the pancreas (or something else not yet understood) that may be a contributing factor in the development of type 2 diabetes mellitus. Studies of skinless potatoes fed to subjects who have fasted overnight (1, p. 93) do show a sudden rise in insulin levels (i.e., the potatoes have a high glycemic index), but a person rarely sits down and eats just potatoes on an empty stomach. For the glycemic index of potatoes to be helpful, insulin levels must be measured when the potatoes have been consumed along with a meal—something that has not been sufficiently studied. There is an important omission in this book. Obesity, hypertension, and diabetes mellitus are epidemic in our society, but they are especially rampant in the lower socioeconomic groups. There are a myriad of reasons for this, but diet is certainly an important one. From a public health perspective, improving the nutrition of this group of people would give us the greatest “bang for the buck.” It would have been nice to see more of Willett's creative energy focused on this aspect of the problem. A couple of other quibbles: Willett advocates taking a multivitamin “for insurance.” Here he departs from recommendations based on research “gleaned from studies that have tracked hundreds of thousands of people for over 20 years” (to quote from the book's jacket) and resorts to personal opinion. (We cannot be too hard on him for this conclusion: Our own UC Berkeley Wellness Letter also advocates a daily multivitamin, but only for older people.) Another: In Willett's introductory chapter, hyperbole may get the better of him when he claims that “a healthy diet teamed up with regular exercise and no smoking can eliminate 80 percent of heart disease and 70 percent of some cancers” (1, p. 15). Willett himself warns us about taking it all too seriously by quoting Mark Twain: “Be careful about reading health books. You may die of a misprint.” Given the caveats mentioned above, one need not “be careful about reading” this book. It is not the long-awaited Holy Grail of human nutrition, and it certainly does not claim to be. What it is, however, is a thoughtful assessment based primarily on epidemiologic studies. Furthermore, it provides, as Willett claims, “a solid sense of state-of-the-art healthy eating today.” Subjecting the discipline of medicine to the rigors of scientific investigation (the catch-phrase today is “evidence-based medicine”) has led us out of many centuries of darkness. Walter Willett is to be congratulated for doing this with nutritional science. Over the next decade, many more studies on nutrition and health will bring forth fruit. We can only hope that Walter Willett will be around to communicate this information to the public. By Walter C. Willett ISBN 0-684-863375, Simon and Schuster, New York, New York (Telephone: 800-223-2336, Fax: 800-943-9831, World Wide Web: www.simonandschuster.com), 2001, 304 pp., Hardcover $25.00 REFERENCES 1. Willett WC. Eat, drink, and be healthy: the Harvard Medical School guide to healthy eating. New York, NY: Simon and Schuster, 2001. Google Scholar 2. Food and Nutrition Information Center, National Agricultural Library, US Department of Agriculture. The Food Guide Pyramid. Beltsville, MD: US Department of Agriculture, 2000. (www.pueblo.gsa.gov/cic_text/food/food-pyramid/main.htm). Google Scholar 3. Jenkins DJ, Wolever TM, Taylor RH, et al. Glycemic index of foods: a physiological basis for carbohydrate exchange. Am J Clin Nutr  1981; 34: 362–6. Google Scholar

Journal

American Journal of Epidemiology – Oxford University Press

Published: Dec 15, 2001

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