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Authors: Joel Fuhrman

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Since most salt comes from processed foods, avoiding added sodium isn't difficult. Resist adding salt to foods, and purchase salt-free canned goods and soups. If you must salt your food, do so only after it is on the table and you are ready to eat it—it will taste saltier if the salt is right on the surface. Condiments such as ketchup, mustard, soy sauce, teriyaki sauce, and relish are all high in sodium. Use garlic, onion, fresh or dried herbs, spices, lemon or lime juice, or vinegar to flavor food. Experiment to find salt-free seasonings that you enjoy.

The Coffee Question

I am often questioned about the health effects of coffee: Can a healthy diet include coffee? Is coffee actually
good
for people?

The good news first. Mysterious protective effects of coffee against diabetes have been reported. A 2010 meta-analysis analyzing data from eighteen studies reported that each additional cup of coffee consumed per day was associated with a 7 percent reduction in risk of diabetes.
40
This was surprising, especially because coffee consumption, both regular and decaffeinated, has been shown to raise glucose levels after a meal; thus you would expect it to worsen diabetes, not help it.
41
The reason for the decreased diabetes risk remains uncertain, but since coffee comes from a dark-colored bean, it is likely that antioxidants, minerals, or other phytochemicals may be responsible. With this in mind, we must remember that almost all the subjects in the observational studies were eating the standard American diet and therefore were starving for antioxidants and phytochemicals.

It is most likely that the standard American diet is so nutrient-poor that a significant portion of people's phytochemical intake comes from their morning coffee! Additional studies support this possibility.
42
Chlorogenic acid and trigonelline, two of the major phytochemicals in coffee, have been shown to decrease blood glucose and insulin concentrations in the blood compared to placebos after ingesting sugar, so these phytochemicals likely increase insulin sensitivity, thereby accounting for the beneficial effects.

It is doubtful that coffee would offer any additional protection on top of a nutrient-dense diet—the responsible phytochemicals can be obtained from other plant foods and the diet would not be so lacking in antioxidants. For example, blueberries contain the antioxidant chlorogenic acid, and the phytoestrogen trigonelline is also found in peas, lentils, soybeans, and sunflower seeds. Again, the only reason that coffee is beneficial is because of the severe shortage of plant-derived phytochemicals in the diet of most Americans.

Please note: the fact that coffee is shown to have some phytochemical benefits offering a degree of protection against one disease or another does not make coffee a health food. Caffeine is still a
drug
. It is a stimulant—it gives you a false sense of increased energy, allowing you to get by with an inadequate amount of sleep. In addition to quantity of sleep, caffeine also reduces the depth of sleep. Inadequate sleep promotes disease and premature aging, and can fuel overeating behaviors. Those who drink caffeinated beverages are drawn to eat more often than necessary because they mistake caffeine withdrawal symptoms—such as shakiness, headaches, and lightheadedness—for hunger. That these detoxification symptoms are mistaken for hunger is understandable, because eating more food helps lessen them.

It is impossible to get in touch with your body's true hunger signals if you are addicted to stimulants. If you do decide to stop drinking coffee, keep in mind that it takes four to five days for the caffeine withdrawal headaches to resolve. If the symptoms are too severe, try reducing the coffee slowly. Losing weight is a more important goal for your overall health than eliminating coffee. But including caffeine does not make it easier to control your appetite and food cravings; it makes it harder.

Decaffeinated coffee is also not without risks. The chemical substances used to remove the caffeine may be hazardous. Drinking decaffeinated coffee is associated with risk of developing rheumatoid arthritis, possibly due to the caffeine-removing additives.
43
For this reason, it is probably safer to choose a water-processed decaf if you choose to drink decaffeinated coffee.

The message here is that coffee can be both good and bad, but its powerful addictive qualities, with the potential for withdrawal headaches and the potential to increase blood pressure, should make people cautious.
44
The most likely risks are almost never mentioned in news reports.

I'll say it again: coffee is a drug, not a food. And like most drugs, it may have some benefits, but its toxic effects and resultant risks may overwhelm those advantages. Caffeine is a stimulant, as noted above, and a long and healthy life is most consistently achieved when we avoid stimulants and other drugs. I do not think anyone should rely on coffee to protect against diabetes or cancer. If you do choose to drink coffee, stick to water-processed (nonchemical) decaf, and, of course, skip the doughnuts.

The Soy Debate

Asian populations have a lower incidence of hormone-related diseases, such as breast cancer, uterine cancer, and prostate cancer, than Westerners do. It has been suggested that soy consumption is one reason for this difference in disease incidence. Women who were born in Asia but migrated to the United States likewise have a lower risk of breast cancer, possibly due to their early exposure to soy. But obviously soy is only one of many factors that influence cancer risk, and now we know that it is
many
contributing factors that make a diet cancer-protective.

It is now clear that soy intake during adolescence, a time when breast tissue is most sensitive to environmental stimuli and carcinogenesis, may reduce the risk of breast cancer later in life. Recent articles in
Cancer Epidemiology
and
The American Journal of Clinical Nutrition
reported that soy consumption during childhood and teenage years reduced the risk of breast cancer in adulthood by 60 percent and 40 percent, respectively.
45

Soybeans are rich in isoflavones, a type of phytoestrogen. Phytoestrogens are plant substances that are chemically similar to estrogen—and since higher estrogen levels promote breast cancer, some people predicted that soy would too. Now we know that the phytoestrogens in soy actually
block
the effects of the body's estrogen. Despite myths propagated on the Internet, the most recent and reliable clinical studies support a strong protective effect of minimally processed soy foods against breast cancer.

In 2006, a meta-analysis in the
Journal of the National Cancer Institute
examining data from eighteen studies on soy and breast cancer that were published between 1978 and 2004 concluded that soy overall has a protective effect.
46
Again in 2008, another meta-analysis in the
British Journal of Nutrition
compiling data from eight studies (which were not included in the 2006 meta-analysis) also concluded that soy consumption decreases breast cancer risk. These effects were dose-dependent—a 16 percent reduced risk for each 10 milligrams of soy isoflavones consumed daily.
47

Soy has protective effects even after a diagnosis of breast cancer. A new study of breast cancer survivors has shown that premenopausal breast cancer survivors who consumed more soy had a 23 percent reduced risk of recurrence.
48

Soy provides protection against other hormonal cancers as well. A meta-analysis of studies on soy consumption and prostate cancer found a 31 percent decrease in prostate cancer risk with a high consumption of soy foods.
49
Soy has also been shown to be protective against endometrial and ovarian cancers.
50

Soy products such as tofu and soy milk can be useful in moving toward a plant-centered diet with less saturated fat, less animal protein, more plant protein, and more fruits and vegetables. In the United States, the majority of our soy intake, which is very low compared to that of Asian countries, is consumed via soy-based additives or isolated soy protein in processed foods.

Please note that
the most healthful soy foods are those that are minimally processed
—these include edamame, tofu, unsweetened soy milk, and tempeh. You should be aware that soy nuts and other processed soy products do not retain much of the beneficial compounds and omega-3 fats that are in the natural bean. The more the food is processed, the more these beneficial compounds are destroyed. Minimally processed soy foods are a beneficial addition to a healthy diet. I do not recommend consuming large quantities of soy products in the hopes of reducing cancer risk, however. A healthy diet should include a variety of beans,
all
of which have beneficial anticancer compounds, and not a disproportionate share of calories from soy. I always recommend the consumption of a broad variety of phytochemical-rich foods to maximize one's health. Beans are no exception—try to include various different types of beans, including soybeans.

Processed foods, because of their low nutrient levels, high amounts of salt, acrylamides, and other toxic additives, should not be considered healthy. Vegetarians and vegans who eat tofu-turkey, soy burgers, soy ice cream, soy hotdogs, soy cheese and other soy-derived processed foods on a regular basis are certainly not eating a healthy diet. Isolated soy protein is a heavily processed food with the natural micronutrients lost in processing. The key to good health is to eat
unprocessed
foods, because their nutrient-per-calorie density is high.

Omega-3 Fatty Acids

Another question I often hear is, How can I incorporate omega-3 fatty acids into my diet?

The American diet is unquestionably too low in omega-3 fats and too high in omega-6 fats. Omega-3 fats reduce inflammation, inhibit cancer development, and protect our brain and blood vessels. The basic building block of omega-3 fats is alpha-linolenic acid (ALA). ALA can be found in most nuts and seeds but is particularly abundant in flax seeds, hemp seeds, chia seeds, walnuts, and leafy green vegetables. Most people do not get enough ALA in their diet.

Among the above-listed foods, flax seeds and hemp seeds have the highest concentration of these essential fats. Besides omega-3s, these seeds also contain phytochemicals, antioxidants, and fibers that have beneficial effects to inhibit prostate, breast, and colon cancers. However, these protective nutrients and cancer-fighting lignans are not present in significant quantities in the
oil,
only in the whole
seed
. Flax seeds are best ground to a fine powder before use because they are difficult to chew and thus may pass through undigested. Once the seeds are ground, store them in the freezer to preserve freshness.

The short-chain omega-3 fats found in seeds, nuts, and greens are the building blocks of the longer-chain DHA fat that our bodies need for proper functioning of our brain, nervous system, and immune system. Besides our own body's production from ALA, we also get EPA and DHA from fish, fish oil, and algae.

Greens, walnuts, and seeds supply ALA

ALA→EPA→DHA

Fish and algae supply EPA and DHA

In the past, fish or fish oil was thought to be the only source of EPA and DHA, but recently EPA and DHA have become available via a vegan source extracted from omega-3-containing algae grown indoors in clean and controlled conditions.

We do not need
lots
of EPA and DHA, but problems may arise when people become deficient in these needed fats. Low EPA and DHA levels have been associated with:

• Heart disease

• Depression

• Cancer

• Anxiety/panic

• Alzheimer's disease

• Hyperactivity

• Attention deficit disorder

• Allergies

• Autoimmune illnesses

• Dermatologic disorders

• Inflammatory bowel disease

Scientists have known for many years that humans can convert short-chain omega-3 fats (ALA) from seeds and greens into the valuable EPA and DHA. The question is, Can we achieve optimal levels without the consumption of fish? Studies show that people have varying ability to convert ALA into DHA, so the answer is ambiguous: some people ingesting ALA from greens, flax, and walnuts can achieve adequate levels of EPA and DHA, while others do not manufacture optimal amounts.
51
Men generally convert less than women, and the ability to convert declines with aging, suggesting that supplements may be more important for older males.

Fish are rich in omega-3s, but fish are concentrated animal protein and accumulate environmental pollutants. Eating too much animal protein raises IGF-1 levels, as we saw, which in turn are linked to cancer.
52
Regarding pollutants in fish, the Environmental Protection Agency warns primarily of mercury, PCBs, chlordane, dioxins, and DDT. High levels of PCBs, chlordane, and dioxins detected in body fat have been associated with threefold to tenfold increases in the occurrence of cancer.
53
The dumping of toxic waste into our oceans has definitely taken a toll. So while DHA is definitely a beneficial fat, we have to reconsider the source in which we find it.

Since fish are highly polluted compared to other foods, we have to take a closer look at the typical recommendations of health authorities to consume more fish. Increasing fish consumption was found to be linked to a modest increase in the incidence of diabetes as well as increased risk of prostate cancer and breast cancer in some studies.
54

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