Introduction

“Let food be thy medicine, and medicine be thy food.”

—Hippocrates

The other day someone asked me whether honey is a good sweetener.

My answer was, “It depends.”

If, by honey, you mean the stuff you buy in the supermarket that comes in the cute little plastic bear, the answer is no. If, by honey, you mean raw, unfiltered, uncooked, unpasteurized organic honey, then the answer is an unqualified yes. Which reminds me of a story.

I was coming out of the multiplex at the Lincoln Center Theater in New York one Friday evening, and just as I was blending into the huge crowd, I ran into an old friend I hadn’t seen in ages. We bumped smack into each other on the escalator going down to the main floor and decided to go to the local Starbucks and catch up. As soon as we sat down, we started talking about the movie. “That was so moving,” I said. “Moving?” she said incredulously. “I thought it was completely maudlin and sophomoric.” “What are you talking about?” I asked. “The acting was incredible, the writing was sophisticated.” “Sophisticated?” she snorted. “Well, maybe if you consider Adam Sandler sophisticated!”

Silence.

We looked at each other…

…and suddenly realized…

…we saw different movies.

There’s a lesson in that, and it has to do with food and language.

The person asking me about honey didn’t make a distinction between the plastic bear kind and the raw unfiltered kind, yet they are two completely different foods. If I had answered the question without knowing which she was talking about, it would have been like discussing the movie, not realizing that one person had seen a drama and one had seen a comedy. You and I could be discussing what it’s like to have a pet, but if you’re thinking monkeys and I’m thinking daschunds, we’re not talking about the same thing, even if we think we are.

I was never more aware of this issue than when I was writing and researching this book. Take salmon. Great food, right? Every nutritionist recommends it. There’s only one problem: Farm-raised salmon is not the same food as wild salmon. As you’ll see, one of them (the wild kind) is loaded with omega-3 fats. Its striking color is the result of it normally dining on krill, which provides it with a highly beneficial compound called astaxanthin, a natural carotenoid that gives salmon its rich color. Farm-raised salmon have never seen krill—they eat grain, which would be like raising lions on chocolate chip cookies. They have—by many accounts—less omega-3 fat than their wild brethren, and their color is the result of whatever selection of dye the factory farmers decide on that day. Not only that, according to the Environmental Working Group, farmed salmon are likely the most PCB-contaminated protein source in the U.S. food supply. Wild salmon and farm-raised salmon are completely different foods. Yet we unknowingly use the same word for both.

Big problem.

Without going too far afield, let me point out that this language problem has a lot to do with the difficulty in drawing conclusions from studies of meat eaters or vegetarians. It’s possible to be a vegetarian eating Twinkies and white rice, and it’s possible to be a vegetarian eating nothing but vegetables, whole grains, fruits, and eggs. Similarly, meat eaters can refer to people who dine exclusively on ballpark hot dogs and have never met a vegetable they didn’t hate, or it can refer to small tribes of hunter-gatherers who dine on pasture-fed wild game—when they can catch it—and tons of fresh, wild vegetables, fruits, and nuts.

See where I’m going with this?

Ten years after the first edition of this book, the problem of language and food is more critical than ever. Almost daily we hear reports about the health benefits (or dangers) of a diet—Paleo, raw food, gluten-free, vegetarian, vegan, low-carb, high-fiber—but does the average consumer even know the exact definition of those terms? The unfortunate truth is no, they don’t.

Even health professionals don’t have great working definitions of these diets. The most touted diet in nutrition history is the Mediterranean diet, typically described as including lots of fish, nuts, vegetables, beans, whole grains, and olive oil, but that’s about as scientific a description of a diet as “it’s awfully hot in here” is of temperature.

You know that low-carb diet study you heard about on CNN? Was it low-carb, high-protein? Or low-carb, high-fat? (They probably didn’t tell you that.) Did the researchers control for fiber intake? And what about the precise meaning of words such as meat or soy? Is all meat the same? (It’s not.) And is fermented soy the same as non-fermented soy? (Nope.) Is wild salmon the same as farmed salmon? (Nope.) Are all omega-3s created equal? (And nope.)

I think you get the picture.

We’ve made a huge mistake by trying to define the perfect diet in terms of protein, carb, and fat quantity—how many calories of each should I consume? We do this while neglecting the role of protein, carbohydrate, and fat quality. Endless diet and weight loss books try to come up with the perfect formula—this many carbs, that much fat, this percentage of protein—when the actual quality of the food is probably much more important for our health than the proportions of fat, carbs, and protein.

Which brings us to this book.

Given the mandate to choose the 150 healthiest foods on the planet, I had to make a lot of decisions. Some were easy, slam dunks, no-brainers. (Think vegetables. There are no bad ones. Unless you count french fries.) Some, because of the language issue discussed previously, required careful exposition. Milk, for example, is a great food in its raw, organic state; but, in my opinion, in its typical homogenized, pasteurized form, it’s a disaster.

So when you read the entries, pay particular attention to those qualifications and caveats. You’ll probably be surprised at some of the foods that made the cut, and even more surprised at some of the ones that didn’t. (See, for example, the entry on soy foods. That is, if you can find it. It’s pretty short.)

At one point, it was suggested that I rate the foods in each category. I didn’t do it. Why? Because foods are like friends: They provide different things. You can have a friend who’s great for going to basketball games with but with whom you wouldn’t think of sharing your innermost feelings. Some foods provide great fats such as omega-3s, but no calcium. Others provide an abundance of vitamins and minerals, but no protein. No food provides everything. Rating them would involve deciding which essential vitamins, minerals, and macronutrients are more important, and that’s impossible. You need them all. However, I did put stars on the foods I thought had exceptional nutritional value.

That said, there are four key factors to be aware of when reading this book. Having a passing acquaintance with them will enrich your understanding of the things that make foods healthy. And I’d like to go over them here, so that when I reference them in the sections on food, you’ll know what I’m talking about. The first is omega-3 fats, the presence of which almost always guarantees a food makes the list. The second is fiber. The third is the glycemic load. And the fourth is antioxidants. Let’s go over them one by one.

• Saturated fat is not always bad. Peer-reviewed studies in major medical and nutritional journals have shown that saturated fat does not play a causal role in heart disease as previously believed. Some sources of it—coconut oil, Malaysian palm oil, dark chocolate, the fat from grass-fed animals—are healthy. You no longer need to avoid saturated fat like it’s poison. It’s not.

• Trans fat, however, is poison. Metabolic poison, that is. It’s found in cookies, crackers, baked goods and snacks, doughnuts, french fries, and most margarines. Regardless of what the label says, if there is partially hydrogenated oil in the ingredient list, it’s got trans fat. Don’t eat trans fats. Period. (The one single exception is the trans fat CLA, or conjugated linoleic acid, which is found naturally in grass-fed dairy and meat and is not man-made.)

• Monounsaturated fat—found in nuts and olive oil—is good stuff and heart healthy.

• Polyunsaturated fats come in two flavors: omega-6s and omega-3s. Though there are some health benefits to omega-6s, we consume too many and not nearly enough omega-3s.

There are three different omega-3 fats: One of them is found in flaxseed and called ALA (alpha-linolenic acid). It’s considered an essential fatty acid because the body can’t make it, so it must be obtained from the diet (more about this in the section on flaxseed and flaxseed oil; see here). But the other two omega-3s—DHA (docosahexaenoic acid) and EPA (eicosapentaenoic acid)—are found in fish such as wild salmon. And these two may be of even more importance to the body than the first one.

Although the body can make DHA and EPA from alpha-linolenic acid (the first, essential, one), it doesn’t do a great job of it. That’s why it’s such a good idea to obtain these incredibly important omega-3 fats ready-made from fish or fish oil (the most potent sources). They’re just so critically important to our health.

So what exactly do omega-3s do and why do we need them? Let’s start with the cell membranes. Omega-3s are incorporated into cells, making their membranes more fluid so they can communicate with one another. This means, for example, that feel-good neurotransmitters such as serotonin and dopamine can get in and out of the cell more easily, translating to better mood. In fact, omega-3s are currently being studied for their positive effect on depression.

They’re also being studied for their impact on behavior, feeling, and thinking. Nearly every study of behavior problems—from simple lack of concentration to actual aggressive behavior in prison inmates—has shown that people with these problems have low levels of omega-3 fats in their bloodstream. This doesn’t mean that omega-3s will fix every behavior problem, but it’s certainly of more than academic interest that this correlation shows up so frequently.

On a side note, the omega-3s in fish have a significant effect on the developing brain of a human fetus. Because the baby’s brain, like your own, is about 60 percent fat by weight, and because most of that fat is DHA (the very omega-3 found in fish), taking fish oil (or getting fat from healthy, wild fish) is one of the absolute best things a pregnant woman can do for her developing baby. Fish truly is brain food. The amount of omega-3’s in a pregnant woman’s diet helps to determine her child’s intelligence, fine-motor skills (such as the ability to manipulate small objects and hand-eye coordination), and propensity to antisocial behavior.

Omega-3s are anti-inflammatory. Inflammation is a critical component of virtually every degenerative disease from heart disease to diabetes to obesity to Alzheimer’s, and inflammation itself has been dubbed The Silent Killer. That makes anti-inflammatory foods and supplements of critical importance to our health. In my opinion, the anti-inflammatory power of omega-3s is one of the top reasons to consume them daily.

Omega-3s also support circulation. They transport oxygen from red blood cells to the tissues. They prevent blood cells from clumping together (remember, blood clots can be a cause of heart attack and stroke). They act as a blood thinner, much like aspirin, only without the side effects. Studies suggest that proper omega-3 intake could save 70,000 lives a year in the United States alone and reduce the number of fatal arrhythmias by 30 percent. Omega-3s help lower blood pressure. And they’re also effective for in improving insulin and glucose metabolism in diabetics.

And eating a high-fiber diet may also help with weight loss. Steven Masley, M.D., and I presented a study at the 2015 annual meeting of the American College of Nutrition showing that fiber intake was one of the best predictors of long-term success on a weight loss program. High-fiber foods generally require more chewing time, giving your body extra time to register the fact that you’re no longer hungry, so you’re less likely to overeat. A high-fiber diet also tends to fill you up longer. And high-fiber diets tend to have more volume for fewer calories, which has been shown in research by Barbara Rolls, Ph.D., at Pennsylvania State University to be a boon to weight management. In an earlier book, I suggested that the number one supplement for weight loss is fiber. (See “The Read Deal on Fiber: It’s Much More Important Than We Thought”.)

Why do we care? Because raising blood sugar raises levels of the hormone insulin, which, if raised high enough and long enough and frequently enough, contributes to diabetes, heart disease, and aging. Emerging evidence has shown that high blood sugar and correspondingly high insulin levels are implicated in Alzheimer’s disease as well, which is now being referred to by researchers as “type 3 diabetes.” Eating low glycemic is a strategy that is virtually guaranteed to contribute to health. When I wax eloquent about a food’s low glycemic impact, that’s why.

Unfortunately, the glycemic index is a misleading measure because it doesn’t consider portion size. The glycemic load is a much more valuable metric, as it accounts for the actual portion size of the food being tested. For now, the take-home point is this: Eat less sugar. And eat fewer foods that convert quickly to sugar in the body (read: almost all processed carbohydrates). If you’re interested in learning more about glycemic index and glycemic load—something I recommend highly that you do—you can start with a blog post I did on the subject. Just type into your search engine: “Jonny Bowden Glycemic Index vs Glycemic Load.”

If you’d like to dig into the science a little deeper, try the article posted on the Oregon State University website at lpi.oregonstate.edu/infocenter/foods/grains/gigl.html.

Finally, the actual tables of the glycemic index and glycemic load for food can be found at www.mendosa.com/gilists.htm. Remember it’s the glycemic load you want to pay attention to.

Oxidation—or oxidative stress—is a factor in nearly every degenerative disease. Antioxidants help fight oxidative damage. Deficiencies of antioxidants are implicated in the early stages of heart disease, cancer, eye disease, and age-related declines in memory. When I tell you that a food is good because it’s loaded with antioxidants, now you know why.

You’ll soon notice that I’m far from fanatical about recommending that you drain every drop of saturated fat from your diet. So inevitably, people ask me, “What about cholesterol?”

After the first edition of this book was published, cardiologist Stephen Sinatra M.D., and I published a best-selling book called The Great Cholesterol Myth. It was featured on Dr. Oz and in a documentary on heart disease produced by the prestigious Australian Broadcasting Company. In fact, it nearly caused an international incident. In that book, we make the case for why cholesterol is wildly overrated as a marker for heart disease risk. It was—to put it mildly—a message that was not exactly embraced by the thirty-billion-dollar industry devoted to cholesterol lowering. Yet, years later, I’m happy to say, even conventional medicine is getting wise to the cholesterol myth.

Cholesterol just might be the most misunderstood molecule in the whole world. John Abramson, M.D., professor of health care policy at Harvard University, says, “It is important to keep in mind that cholesterol is not a health risk in and of itself. In fact, cholesterol is vital to many of the body’s essential functions.” Cholesterol is the parent molecule of some of the body’s most important compounds, including the sex hormones and vitamin D. It’s also an integral part of the cell membrane.

What a lot of people don’t realize is that the vast majority of cholesterol is made in your body, by the liver. If you take in more from the diet, the liver makes less. If you take in less, the liver makes more. You need cholesterol. Without it, you’d die.

Doing justice to the whole cholesterol question in an introduction as short as this is a challenge, but I’d like you to have a few basic take-home points. The first is that dietary cholesterol—like the kind you find in egg yolks—has minimal impact on serum cholesterol (the kind in your blood that your doctor measures). Minimal. I’m delighted to report that since the original edition of this book was published, the U.S. government has recognized the truth of this. The most recent version of the U.S. Dietary Guidelines states that “cholesterol is not considered a nutrient of concern for overconsumption.” All I can say is it’s about time.

The effect of eggs on heart disease has exactly zero to do with their cholesterol content. Eggs contain many valuable nutrients, such as protein, choline (which is great for the brain), eye-nutrition superstars, such as lutein and zeaxanthin, healthy fat, and a smattering of vitamins and minerals. And the cholesterol in them is a good thing, not a negative. As Walter Willett, M.D., Dr. P.H., professor of epidemiology and nutrition at Harvard’s School of Public Health and a professor of medicine at Harvard Medical School, has said, “No research has ever shown that people who eat more eggs have more heart attacks than people who eat few eggs.”

The second point has to do with the demonization of saturated fat in general. Yes, saturated fat raises cholesterol but, as we point out in The Great Cholesterol Myth, you have to look under the hood to see that saturated fat’s overall effect on cholesterol is positive. Saturated fat raises LDLa (the innocuous kind of LDL cholesterol), lowers LDLb (the “bad” kind of LDL), while raising HDL—all of which are good things. Leaving aside the relationship between saturated fat and cholesterol, the relationship between saturated fat and heart disease—which is what we really care about—has been shown in several major studies over the past few years to be basically nonexistent.

Lowering cholesterol is big business. In 2005, when the first edition of this book was being written, the cholesterol-lowering drug Lipitor was the most prescribed drug in the country. The class of cholesterol-lowering drugs to which Lipitor belongs are known as statins. In that same year, statins were the top-selling class of drugs in the country with 144.5 million prescriptions generating $16 billion, in U.S. sales alone. By 2011–2012, the most commonly used individual drug in America was simvastatin (Zocor), taken by roughly 8 percent of adults in the United States. An astonishing 50 percent of men ages 65 to 74, and 39 percent of women ages 75 and older were on statin drugs, despite evidence from the ongoing Framingham Heart Study that high cholesterol is protective in older people, and despite a complete absence of evidence that statin drugs are beneficial to people in their 70s.

It’s worth noting that many researchers believe that the good that statin drugs accomplish has much less to do with their ability to lower cholesterol than their ability to lower inflammation, which is indeed a definite risk for heart disease, as well as a component of Alzheimer’s, obesity, and diabetes. The foods in this book are filled with natural anti-inflammatories such as the flavonoid quercetin, for example. Spices such as turmeric are so incredibly healthy largely because they are powerful anti-inflammatories. Maybe we wouldn’t need $13 billion a year’s worth of drugs if we ate more of the foods that accomplish the same thing.

Finally, in my opinion, we’ve been way too focused on lowering cholesterol and not focused enough on lowering heart disease and mortality. They are not the same thing. In the Lyon Diet Heart Study, people who had had a heart attack were either counseled to eat a Mediterranean-type diet (fish, fruits, vegetables, whole grains, olive oil, nuts) or given routine post–heart attack advice (watch your cholesterol, eat less saturated fat). The people on the Mediterranean diet experienced 70 percent less heart disease than the group getting the standard advice, about three times the reduction in the risk of further heart disease achieved with statin drugs! Their overall risk of death was 45 percent lower than that of the group getting the conventional advice. And—get this—their cholesterol levels didn’t change much. Though they had significantly less heart disease and less risk of dying, their cholesterol levels pretty much didn’t budge.

Though some studies have shown a reduction in heart disease with cholesterol-lowering medications, the amount of reduction pales when compared to what’s achievable with lifestyle changes. High-risk men in the WOSCOP study (a statin drug study) achieved about a 30 percent reduction in heart disease by going on drugs, but the women in the Nurses’ Health Study showed 31 percent reduction in heart disease just by eating fish once a week. As Harvard’s John Abramson, M.D., puts it, “Most of our health is determined by how we live our lives.”

In the section on meat and poultry, I address the issues of grass fed and free range, because the terms apply to that category. But “organic” is a label we see everywhere and it is used on everything—from fruits and vegetables to Captain Hickory’s Chocolate Crunchy Cereal. What does it mean, anyway? Should we pay attention? And if so, why?

Despite the food industry’s best efforts to make us think our food just magically appears in the supermarket aisle, our food comes from somewhere. And where it comes from—where and how it grows in the case of plants, and what it eats and how it was raised in the case of animals—has everything to do with its quality. So, let’s start with a basic premise: The quality of the food we eat comes from the quality of the food our food eats.

This maxim even applies when we’re talking about fruits and vegetables. Early studies showed that carrots grown in one section of the country did not have the same nutrient composition as carrots grown in another region. The practice of studying this sort of thing was abandoned because it outraged farmers. Grapefruit growers in one part of the country did not want data out there showing that grapefruit grown in another part of the country had more vitamin C. Agribusiness is dedicated to selling us the concept that “carrots are carrots, beef is beef.” Of course, that’s demonstrably not true. For example: On a gram-for-gram basis, a California avocado has 77 percent more monounsaturated fat, 44 percent more potassium, and 21 percent more fiber than its Florida counterpart.

If a fruit or vegetable is grown in soil depleted of minerals, it’s going to be less nutritious than one that’s grown in soil that’s rich in nutrients. In fact, studies of fruits, vegetables, and wheat have revealed a 5 to 35 percent decline in some key vitamins, minerals, and protein over the last half-century. If an apple is sprayed with a ton of chemicals or pesticides—and artificially treated to make it bigger, rounder, redder, more uniform, polished, and more appealing to the eye—it stands to reason that a chemical analysis of that apple is going to look different than one of an apple growing wild on a farm somewhere.

The organic movement valued—even idealized—a time and place where animals were not fed growth hormones, steroids, and antibiotics; where crops were left to fend off the elements with their own protective antioxidants and anthocyanins, rather than chemical pesticides and carcinogens; and where “Roundup Ready,” genetically modified plants (GMO) were unknown. People who wanted organic food were voting for their health and against a marketplace that was increasingly providing them with “food products” bearing less and less resemblance to anything that could once be considered real or whole food—stuff that grew out of the ground, fell from a tree, or was harvested from healthy animals grazing on pasture or wild fish from uncontaminated waters. Buying organic represented a return to natural—and presumably healthier—foods.

At least that was the hope.

So yes, I buy organic whenever possible. I just don’t kid myself anymore that the label refers to something that came from a farm like the ones on which I collected eggs from the barnyard as a kid.

If you’re lucky enough to be able to do that, you’ll be giving yourself a real gift.

I do: There is no perfect diet for humans.

People have lived and thrived on high-protein high-fat diets, on low-protein high-carb diets, on diets high in raw milk and cream, and even on diets high in animal blood (the Masai). And they’ve done so without the ravages of degenerative diseases that are epidemic in modern life—heart disease, diabetes, obesity, neurodegenerative diseases, osteoporosis, and cancer.

Here’s what they haven’t done: thrived on food with bar codes. Nor, for that matter, on food you could pick up in less than a minute at a drive-through.

More than anything else, the take-home message of this book is: Eat real food. Stuff your grandmother would have recognized as food. Stuff that usually doesn’t come in a package. What you eat probably doesn’t ultimately matter as much as how much processing it’s undergone. Real food—whole food with minimal processing—contains a virtual pharmacy of nutrients, phytochemicals, enzymes, vitamins, minerals, antioxidants, anti-inflammatories, and healthful fats, and it can keep you alive and thriving into your tenth decade.

Remember, how you eat is as important as what you eat. Mindfulness and consciousness in eating—as in everything else in life—contribute to health and well-being.

Whether you’re driving a car, building a relationship, or eating a meal, paying attention to what you’re doing makes a difference.

Do it. Savor each moment—and each morsel.

And enjoy the journey.

—Jonny Bowden

THE EXPERTS’ TOP TEN LISTS

The Experts Speak

So much of my work centers on nutrition and health, and I’m frequently asked by friends—or even by strangers who just discovered I’m a nutritionist, probably because I was expounding too loudly on some health-related issue—the following question: “So what do you eat, anyway?”

Which got me thinking.

Not about what I eat—I already know the answer to that. But about what other experts who are conversant with the concepts in this book eat. After all, all of them know what foods are good for you and why—but it might be interesting to see what they actually do eat. One time, when I was speaking at the world-renowned Boulderfest annual conference on nutritional medicine, Robert Crayhon—the brilliant founder and organizer of Boulderfest—asked each of the speakers to write down what we had for breakfast that morning and to list a typical day’s food. The seminar attendees found it interesting to read what the “experts” ate on a daily basis.

Hence my “ask the experts” sections, peppered throughout the book.

Here’s what I did: I went to my database and started calling up some of the best people in the field and asking them if they’d submit a list of their top ten favorite healthy foods. The ones they actually ate, not just the ones they thought were the healthiest. All of them were kind enough to say yes, and the results are sprinkled throughout this book.

Many are authors of best-selling books on health, diet, and nutrition; one, Alan Gaby, is practically a legend in the field of complementary medicine; others including nationally known expert on hypertension and metabolic syndrome, an acclaimed medical educator, a well-known academic researcher in the field of diet, and extraordinary nutritionist and media personality. Many fit into several categories—writers as well as practitioners. All are, in my humble opinion, brilliant.

I gave them all one mandate: Tell me your top ten healthy foods. Then I allowed them to interpret that instruction in any way they chose, including extending the list to eleven or twelve. I think you’ll find the results amusing and instructive.

For those of you who are inclined toward statistics and graphs and like betting on the office pool for the Academy Awards, it’s amusing to notice which foods got the most votes and which were bypassed completely. The clear winners were blueberries (and other berries), spinach (and kale), nuts (especially almonds), broccoli, and wild salmon, with grass-fed beef a very close runner-up. There were some surprises (coffee got mentioned twice), some new stars (pomegranate and sea vegetables), and some notable absences (not one person mentioned soy—not as surprising as you might think—see my essay on soy, shown here). Anyway, I thought it was interesting, and I hope you do, too.

If you’re aching to know what I personally eat, I’ll tell you: oatmeal, pastured bacon, raw certified organic milk, eggs, blueberries, spinach, cherries, sardines, kale, whey protein powder, free-range beef, apples, wild salmon, turmeric, full-fat yogurt, figs, cheese, nuts, watermelon, fresh cold-pressed juices, Malaysian palm oil, coconut oil, avocado, green tea, fresh vegetable juice, and green drinks. There, now you know. And, of course, if I’m being honest, ice cream.

Read the entries and you’ll know why I—and so many of the experts—love those foods. I hope you will, too.