March 7, 2023 -- If you think the biggest risk factor to good health is smoking or genetics, think again.
According to Stephen Kopecky, MD, a preventive cardiologist at the Mayo Clinic, “nutrition is now the number one cause of early death and early disease in our country and the world." Moreover, he says that while having genes for disease will increase your risk by 30% to 40%, having a bad lifestyle for disease will increase your risk by 300% to 400%.
About 20 years ago, Kopecky says, the cause of death worldwide changed from infection to non-infection (like non-communicable diseases). “In those last 20 years, that's grown in terms of what kills us and what gets us sick,” he says. “The three big non-communicable diseases are heart disease, cancer, and rapidly rising is Alzheimer's. But there’s also diabetes, obesity, and high blood pressure — all those things are also related to diet.”
Forty-eight-year-old James, of Fredericksburg, VA, knows this all too well. James asked that his last name not be printed, to protect his privacy. For the last 30 years, he’s been managing type 1 diabetes and complications of insulin resistance, along with high blood pressure, high cholesterol, thyroid disease, and low testosterone. As a former Division 1 college athlete, James exercised regularly and ate what he believed to be a responsible diet.
“Those weirdos in the gym at 5 a.m. who eat chicken salads for every lunch? Yeah, that’s me,” says James.
But he went from a playing weight of 202 pounds to 320 pounds, despite continuing to lift weights and do cardiovascular exercise at least 5 days a week. “Whenever I went to the doctor and stepped on the scale, I got skeptical looks when I made claims of ‘exercising and eating right.’ In all honesty, I thought I was,” says James, noting he followed a low-carb, high-protein diet. “But I didn’t count calories or consider the impact of fat on my already insulin-resistant body,” he says.
After visiting many health professionals, James finally found success with Nancy Farrell Allen, a registered dietitian nutritionist.
Previous doctors applauded his diet, but Allen explained that his insulin resistance was linked to the amount of fat James consumed. “The more fat in my system, the more insulin I needed to inject,” he says. “The more insulin I injected, the more weight I’d gain. The more weight I’d gain, the more insulin I’d inject, continuing this regrettable cycle.”
Allen suggested he shift his diet to a more balanced approach, with a strict eye on fat. “She completely changed my way of thinking about food, broke my belief that all carbs are bad, helped me identify my daily caloric needs, and focused me on eating a balanced diet enriched with fiber,” says James, who then lost 45 pounds in 3 months. “I found myself having more energy, sleeping better, focusing better, and taking less insulin than I had in nearly 20 years,” he says.
Another patient, Sheila Jalili of Miami, took a proactive approach to her health when she turned 40, getting some tests and lab work done for a baseline comparison. “My BMI was around 20, I exercise every day, and I don't have any diseases in my family,” Jalili says, noting everything checked out fine.
She continued her annual checkups and tests, noticing her triglycerides and cholesterol numbers increasing. When her cholesterol reached alarming levels and her triglycerides skyrocketed to 1,230, she met with Kopecky, the Mayo Clinic cardiologist, who prescribed fish oil and asked about her diet. Jalili started tracking what she ate and did an exhaustive review of her fridge contents, noting the sodium levels, cholesterol levels, and fat levels in the foods.
To her surprise, she discovered she ate a lot of unhealthy carbs and fats. “I went into overload. I changed everything. I did so much research,” she says. After 42 days of eating extremely healthy, she dropped her total cholesterol by about 100, halved her HDL, and reduced her triglycerides from 1,238 to 176.
A bad lifestyle often starts with what you eat — and what you don’t. Even if you think you’re eating healthy, you might want to revisit your diet. In particular, reconsider ultra-processed foods (like doughnuts, hot dogs, and fast-food burgers). Though convenient and affordable, they’re inflammatory and, over time, can cause many health issues.
"It bothers our tissues, our heart, our arteries, our brains, our pancreas, our liver, and our lungs, and that leads to disease," Kopecky says. "It could be in the brain with Alzheimer's, the heart with coronary artery disease, or cancers elsewhere."
Ideally, you’d immediately overhaul an unhealthy diet. But that’s not a reality for most people. Making sweeping changes all at once can feel overwhelming. Take small steps instead.
Baby-Step Your Way to a Healthier Diet
Before making any dietary changes, Selvi Rajagopal, MD, MPH, advises having a conversation with your health care provider to figure out your specific health status. Rajagopal, assistant professor of medicine at Johns Hopkins University, says that, generally speaking, everyone will benefit from eating a balanced, healthy diet filled with a variety of nutrient-rich foods.
That includes fruits, vegetables, whole grains, lean protein, low-fat/fat-free dairy, and healthy fats. However, talking with your doctor can help you identify any specific nutrient deficiencies, health issues, and lifestyle factors that need to be addressed. Then you can devise a healthy eating plan that works specifically for your needs.
Revamp how you organize your refrigerator. Most refrigerators put two opaque drawers labeled “Fruits” and “Vegetables” at the bottom, where you’re least likely to see them. Kopecky advises moving your produce to eye level and put the less-healthy options in those bottom drawers. “When we open the fridge, that's what we see, and that's what we tend to eat,” he says.
Change your perspective. “There isn't one healthy weight or one healthy size,” says Rajagopal. Don’t aim for a number on the scale or a certain BMI or certain clothing size. Every body is different, not only in shape and size, but in health risk factors. Also, many people feel really overwhelmed trying to “be healthy.” Rajagopal says, “Healthy is just trying to do something to improve your health, and that improvement can be really small.”
Understand how to read food labels. Allen takes every patient to the grocery store to read and understand food labeling and to highlight different foods. She shares the guidelines below with her patients.
- Fat: Low-fat foods contain 3 grams of fat or less per serving.
- Sugar: Four grams equal 1 teaspoon. When a serving of sugar lists 12 grams of sugar in a 2/3-cup serving, that means it contains roughly 3teaspoonsof sugar.
- Fiber: A naturally high-fiber food can contain about 5 grams of fiber per serving.
- Sodium: A low-sodium food contains less than or equal to 140 milligrams of sodium per serving.
- Protein: Seven grams of protein equal about 1 ounce of protein.
This approach is particularly important as the FDA is exploring a change in which foods can be labeled as healthy. The agency in September unveiled a proposed rule to try and counter the fact that, as the agency claims, more than 80% of people in the U.S. aren’t eating enough vegetables, fruit, and dairy. And most people consume too much added sugars, saturated fat, and sodium.
Under the proposed rule, in order to be labeled “healthy” on food packaging, products must contain “a certain meaningful amount” of food from at least one of the food groups or subgroups (e.g., fruit, vegetable, dairy, etc.) recommended by the agency’s dietary guidelines.
They must also stick to specific limits for certain nutrients, such as saturated fat, sodium, and added sugars.
Breakfast cereals, for example, would need to contain 0.75 ounces of whole grains and contain no more than 1 gram of saturated fat, 230 milligrams of sodium, and 2.5 grams of added sugars to qualify, the agency said.
Don’t fear carbs or fat! Your body needs both to survive, as carbs help fuel your body and fat helps your body absorb fat-soluble nutrients like vitamins A, D, and E. But not all carbs or fats are equal. Choose complex carbohydrates found naturally in plant-based foods (like fruits, vegetables, and whole grains) over simple carbohydrates often found in processed foods (like white bread, enriched pasta, and white rice).
Similarly, strive to include healthy, unsaturated fats (including polyunsaturated and monounsaturated fats) found in foods such as fatty fish, vegetable oils, avocadoes, and some seeds and nuts. Avoid foods with unhealthy saturated and trans fats found primarily in animal products (such as meat, eggs, high-fat dairy) and highly processed foods (frozen pizza and microwave popcorn). “Having a baseline understanding of what this means makes you a much savvier consumer,” says Rajagopal, who suggests going to the U.S. Department of Agriculture’s website to learn about these food components.
Adopt healthier cooking methods. Maybe you’re buying healthy foods but preparing them in unhealthy ways. That lean, skinless chicken breast just got a lot less healthy once you breaded it, deep-fried it, and smothered it with cheese. Allen suggests lighter, leaner techniques such as baking, roasting, grilling, and steaming. “Frying, sautéing, breading, au gratin, buttery, and Alfredo all add additional calories to burn off,” says Allen.
Start small. Eliminate the all-or-nothing thinking, such as, “I want to cut out all sugar” or “I want to cook all my meals at home.”
If you’ve been eating sugar your whole life or eating dinner out 5 nights a week, eliminating this bad habit at once is a huge undertaking. Instead, start small. For instance, reduce one sugary food item you frequently eat.
“Maybe it's soda,” says Rajagopal. “Maybe you go from four cans of soda a day to two cans. Make one change and see how it goes for a week or two.”
Ditto for cooking — aim to add one more home-cooked meal a week rather than trying to cook at home 7 days a week. She also advises bringing in an accountability buddy to help you stay on track.
Take one bite. “If you take a bite of a ground meat or sausage and replace that with a bite of something that's a little healthier — like black beans or a vegetable — then, after doing this for a couple of years, that actually reduces your risk of heart attack and reduces your risk in the long-term of cancers and Alzheimer's,” advises Kopecky. “Literally one bite difference.”
By making small, consistent changes, they can have a big impact over time. Pick one tip that resonates most, implement it, and stick to it until it becomes second nature. Once mastered, move on to another tip, building on that foundation of success.