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Eat, Drink, and Be Healthy: The Harvard Medical School Guide to Healthy Eating Hardcover – July 31, 2001
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Aimed at nothing less than totally restructuring the diets of Americans, Eat, Drink, and Be Healthy may well accomplish its goal. Dr. Walter C. Willett gets off to a roaring start by totally dismantling one of the largest icons in health today: the USDA Food Pyramid that we all learn in elementary school. He blames many of the pyramid's recommendations--6 to 11 servings of carbohydrates, all fats used sparingly--for much of the current wave of obesity. At first this may read differently than any diet book, but Willett also makes a crucial, rarely mentioned point about this icon: "The thing to keep in mind about the USDA Pyramid is that it comes from the Department of Agriculture, the agency responsible for promoting American agriculture, not from the agencies established to monitor and protect our health." It's no wonder that dairy products and American-grown grains such as wheat and corn figure so prominently in the USDA's recommendations.
Willett's own simple pyramid has several benefits over the traditional format. His information is up-to-date, and you won't find recommendations that come from special-interest groups. His ideas are nothing radical--if we eat more vegetables and complex carbohydrates (no, potatoes are not complex), emphasize healthy fats, and enjoy small amounts of a tremendous variety of food, we will be healthier. You'll find some surprises as well, such as doubts about the overall benefits of soy (unless you're willing to eat a pound and a half of tofu a day), and that nuts, with their "good" fat content, are a terrific snack. Relying on research rather than anecdotes, this is a solidly written nutritional guide that will show you the real story behind how food is digested, from the glycemic index for carbs to the wisdom of adding a multivitamin to your diet. Willett combines research with matter-of-fact language and a no-nonsense tone that turns academic studies into easily understandable suggestions for living. --Jill Lightner
From The New England Journal of Medicine
There is an interesting dilemma for those who would influence nutrition. In many places in the world, there are governmental agencies concerned with food security, food safety, agriculture, health, and trade that may, from time to time, implement policies that are at least intended to reduce the risk of chronic diseases. Most often, when the goals of agriculture and human health clash, it is the will of the agriculture sector that prevails (remember the European Union's ``butter mountain'' and ``wine lake''?). In the United States, perhaps more than anywhere else, this has left an opening for self-help nutrition books. In a land where individuality and self-reliance are valued above many other virtues and where disease is sometimes seen to be a mark of personal failure, gaining access to the best data on health-related food consumption may be central to maintaining control over one's health. The quality of such books varies enormously, from the bizarre to the mundane. The feature they share is the promise of better health and control over one's destiny. Only occasionally do bona fide researchers step into the maelstrom. Enter Walter Willett of Harvard University and Eat, Drink, and Be Healthy.
Willett's book is based on evidence derived almost exclusively from large cohort studies of diet and disease. He has been the architect of several such studies and is a major contributor to what we know about methods of collecting and analyzing data; he formerly served the Journal well in this capacity. His position in this regard is preeminent but not unchallenged. He encapsulates his position on the evidence in a new ``Healthy Eating Pyramid,'' a gauntlet thrown at the feet of the U.S. Department of Agriculture (USDA). He notes that the USDA Food Guide Pyramid, like Rudyard Kipling's elephant's child, got pulled into shape by competing interests, few of which cared about human health. He goes on, ``You deserve more accurate, less biased, and more helpful information than that found in the USDA Pyramid.'' Thus, the book brings us the promise of science in the service of nutrition, and as with any good scientific claims, Willett makes sure we know, up front, that all findings are provisional and all recommendations subject to change.
The central chapters of the book are derived from and explicate the layers of the new pyramid. Central to Willett's recommendations is the control of body weight, in which exercise, rather than caloric restriction, has the primary role. However, there is also helpful and practical advice on defensive eating strategies; for example, Willett states, ``Recognize that we are victims of our culture, one that glorifies excess.''
Indeed, much of what is presented in the book is sensible and practical and demystified. For example, the data and associated recommendations on fluid intake include the following: we should drink water; tap water is OK; soft drinks are full of empty calories; and fruit juice contains more beneficial substances and less sugar than soft drinks but cannot simply be substituted for water, because, of course, it does contain calories. There is also useful information on more arcane subjects: for instance, we should be careful of grapefruit juice because it modifies the absorption and metabolism of a variety of drugs in ways that may be detrimental. And there is a proper assessment of coffee drinking that I like to summarize as follows: If drinking moderate amounts of coffee is your worst nutritional vice, you are in excellent shape. Even in the area of alcohol, Willett, who has been and remains a champion of the beneficial effects of moderate consumption (which he has the courage to define), notes that if you do not drink alcohol you should not ``feel compelled'' to start. Possibly, this is a nice antidote to the widely held notion that if some is good, more is better, but his choice of words is just a little disturbing. Finally, although many self-help books with much poorer pedigrees than this one offer recipes, it is not often that they include useful rules of thumb about shopping and places to shop and even practical tips on how to make substitutions in recipes.
Are there areas where Willett's Healthy Eating Pyramid and the associated information may not be warmly embraced by others in the nutrition-and-disease research community? Certainly the switch from vilifying total fat (a position Willett abandoned early) to asserting that carbohydrate is the bad guy (a position that Willett has made his own) and that there are ``good fats'' and ``bad fats'' does not meet everybody's sniff test. The field of nutrition and chronic disease is populated by those who will agree with Willett on none, one, two, or all three of these positions. It is probably fair to say that reality is not as clear as this book suggests. It is quite clear that diets high in potatoes, olive oil, or even sugar are not harmful to all (or beneficial to all). It seems probable that in the future there will be increasingly clearer advice that is based on metabolic variations -- variations in body shape and fat distribution and subtle genetic differences in the capacity to handle major nutrients -- and that echoes what we already know about micronutrients. It may well be that the ability to handle specific foods and nutrients differs substantially from person to person and that the only universal may prove to be Willett's central tenet: match the energy ingested to the energy expended by controlling both eating and exercise.
It is an interesting paradox that doctors, scientists, and engineers are highly regarded in Western societies but that only a minority of people in those societies like reading about science or are even interested in the topic. Couple that with data from Robin Dunbar of the University of Liverpool in Britain, who found that perhaps two thirds of all human speech is gossip, and it will not be surprising if Willett's book (perhaps like those by Stephen Hawking) sells well but has no impact at all on human behavior or even understanding.
John D. Potter, M.D., Ph.D.
Copyright © 2002 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
Top customer reviews
1. As one reviewer stated, the book is ten years old (with a six year old revision), so it's no longer cutting edge. Lots of what is said is all over the media, like the benefits of nuts. And much as I appreicated the discussion of overhyping calcium, there is more to dairy than just calcium and it's quite possible that milk products may be much better than the author thought in 2000. Yogurt especially should be considered as a potential health food. None of this is a refection on the author, of course, but just the inevitable impact of age on a book of this sort.
2. Like so many books about food, the author is a bit sanguine about the difficulties of adopting a new diet. His diet plan is far less restrictive than some, but readers should still be prepared for just how much they will still crave foods like white bread and sweets. Far from being a social construct as the book suggests in one spot, the human preference for rich and highly refined foods is inborn and (I would speculate) based on the fact that such foods are simply easier to eat and digest.
3. My personal approach is to buy the most natural food I can under most circumstances. Much as it recommends whole foods like grains and nuts, the book does not really discourage use certain margarines and artificial sweeteners. I would generally avoid such things simply based on the past experience that many factory foods have turned out to have more problems than anticipated.
4. I would make more assertive use of supplements than the book recommends. I typically take 8 or 9 different tablets daily, including extra D and a B complex, and I think it is helpful.
When it comes to exercise, healthy eating and weight loss, there is no such thing as "easy". There is such a thing as "possible", and this author does a pretty good job of getting us thinking on that track.
This is all good advice, but it's merely an introduction to nutrition and doesn't take into account different lifestyles. The authors are writing this book for a general audience, which often means people who sit in the office all day and gobble down their processed fast food in their fifteen-minute lunch breaks.
So some of the author' advice should be taken with a grain of salt. For example, the authors caution that too much protein intake (their recommended daily dosage is 48 grams of protein) would cause acidity in the body, forcing the bones to release calcium to achieve homeostatis. But what about athletes and individuals who exercise regularly? Then it's important to take protein supplements because one's diet cannot supply all the protein that the body needs to grow the muscle cells.
Nevertheless, this is an excellent introduction to the food issues that most people face today.
This book introduces a new food pyramid based on the latest information from several large scale nutrition and health studies. It dispels myths contained in the official food pyramid, low-fat and low-carb diets. It redefines good and bad fats, presents carbs based on glycemic index, and suggests different daily doses of vitamins in some cases than FDA daily recommendations. Some of these things may not be news to many readers - I did learn some interesting new facts (e.g. soy proteins not as great for you as thought earlier).
I like how the author puts weight management and daily physical activity as the basis of his new food pyramid. Also, his tone is calm and professional, and there are many references to authoritative scientific studies. When there is contradictory scientific evidence, esp. about some widely held belief (e.g. "eggs are bad for you"), he tells you so. At least a third of the book is taken up by recipes, which I found strange given the explanatory tone and content of the rest of the book.
Weaknesses of this book:
- does not individualize recommendations by gender, body type, race, etc
- does not address food combinations and interactions (e.g. for some people, fish and dairy do not work well together in the same meal, but stuff like that is not covered)
- does not really provide weight loss advice, even though he mentions obesity as a prevalent issue, explains BMI, etc
- rather generic at the end of the day
- font is annoyingly tiny (probably not author's fault but makes it harder to read)
Overall, a good read to bring you up to speed on nutrition. However, if you are well read on this topic already, you will find this book too basic and redundant.