FOOD CHOICES FOR A HEALTHY PLANET

Food and Personal Health

EXPLAINED

Introduction

Lana Vanderlee
Assistant Professor

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DIET AND HEALTH ARE INEXTRICABLY LINKED – whether it’s not enough food, too much food, not the right types of foods, or unsafe food, diet is the biggest contributor to disease and death in the world. Experts from across the globe in the areas of research, policy and practice have come together in these pages to help explain some of the common and perplexing questions about the relationship between diet and health. This section explores a range of topics, discussing trends about consuming whole foods compared to ultra-processed foods, what types of vegetables you should aim to eat, whether organic foods really are healthier for you, and more, all explained by a mix of world leaders sharing their interpretation of the most current science.

Marie Spiker
Healthy and Sustainable Food Systems Fellow
ACADEMY OF NUTRITION AND DIETETICS FOUNDATION

Food processing is a spectrum, not a binary state. At the “minimally processed” end of the spectrum, fresh vegetables, fruits, whole grains, nuts, meats, and dairy products might be sliced, filtered, pasteurized, fermented, frozen, or vacuum-packed so they are more appealing, convenient, safe to eat, or can be stored for longer. Also at this end of the spectrum are grains, seeds, and nuts that have been ground, milled, or pressed to make flour, pasta, and oils. In the middle of the spectrum are processed foods with added sugar, salt, or fat — think bread, some cheeses, and canned vegetables, beans, or fish. At the “ultra processed” end of the spectrum, foods may include artificial colors, flavors, preservatives, and other additives (like emulsifiers or bulking agents) for taste, texture, and shelf stability; think of sugary beverages, packaged snack foods like chips and cookies, sweetened breakfast cereals, and many frozen meals. So, “processing” itself is not inherently bad — some processes like canning and freezing can help to preserve the nutritional quality of fresh foods — but ultra processed foods tend to be lower in fiber and micronutrients and higher in sugar and salt.

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HARVARD SCHOOL OF PUBLIC HEALTH – Processed Foods and Health

Monteiro, C. A., Cannon, G., Moubarac, J.-C., Levy, R. B., Louzada, M. L. C., & Jaime, P. C. (2018). The UN Decade of Nutrition, the NOVA food classification and the trouble with ultra-processing. Public Health Nutrition, 21(1), 5–17. https://doi.org/10.1017/S1368980017000234

Monteiro, C. A., Cannon, G., Lawrence, M., Louzada, M. L. C., & Machado, P. P. (2019). Ultra-processed foods, diet quality, and health using the NOVA classification system. Food and Agriculture Organization of the United Nations.

Monteiro, C. A., Cannon, G., Levy, R. B., Moubarac, J.-C., Louzada, M. L., Rauber, F., Khandpur, N., Cediel, G., Neri, D., Martinez-Steele, E., Baraldi, L. G., & Jaime, P. C. (2019). Ultra-processed foods: what they are and how to identify them. Public Health Nutrition, 22(5), 936–941. https://doi.org/10.1017/S1368980018003762

Christopher Gardner
Rehnborg Farquhar Professor
STANFORD SCHOOL OF MEDICINE

An important risk factor for type 2 diabetes is excess body fat, and so one of the ways to prevent diabetes is to develop eating habits that allow you to maintain a healthy weight, without excess body fat. However, there are people who have a healthy body weight, and still develop type 2 diabetes, so a healthy weight alone is not enough to prevent diabetes. This disease involves an inability to properly control blood levels of glucose. It is quite possible to have a healthy body weight, but consume the types and amounts of foods that lead to high blood glucose levels. The types of foods that do this are sugary, or high in refined carbohydrates such as white bread – the carbohydrates from those foods are rapidly digested and absorbed, making it hard for the body to keep up. In contrast, the carbohydrates that are found in whole plant foods such as beans, vegetables, whole intact grains and fruits, come with fiber that helps slow the digestion and absorption of carbohydrates. A healthy Mediterranean type diet is a good choice for preventing diabetes, because it is a combination of healthy high carbohydrate plant foods that are high in fiber, as well as healthy fats from olive oil, nuts, seeds, avocadoes and fatty fish which can help keep down the total proportion of carbohydrates – foods with healthy carbs and healthy fats, for a healthy balance.

Carlos Monteiro
Professor of Public Health Nutrition
UNIVERSITY OF SAO PAULO, BRAZIL

Geoffrey Cannon
Specialist in international food and nutrition policy
UNIVERSITY OF SAO PAULO, BRAZIL

Carlos Monteiro: Instant noodles are not a form of pasta. Instant noodles, also known as ramen, invented in Japan in the 1950s, and also pot or cup noodles, invented in the 1970s, are ready-to-consume, multi-ingredient, hyper-palatable industrial products made from wheat flour with water added, prepared usually by flash frying usually in palm oil or other vegetable oil or else by air drying, then pressed. They contain many additives, notably flavors that may be packaged separately, designed to give to the product the taste of chicken, shrimp, beef, chili, or other real foods. Bits of vegetables are sometimes added to pot or cup noodles to give a ‘healthy’ impression. Vitamins and minerals may be added with the same purpose. They are usually eaten alone, mostly as snacks. As such, instant noodles are classified by the NOVA food system in its fourth group of ultra-processed foods. There is mounting evidence in the scientific literature that, through different mechanisms, increased ultra-processed food consumption increases the risk of several chronic diseases including obesity, diabetes, hypertension, cardiovascular diseases, cancer and all-cause premature mortality.

Geoffrey Cannon: Spaghetti and pastas of all forms, probably originated in Italy around the 13th century CE, are usually made from durum wheat (semolina), with water added and sometimes egg, then dried and cut or extruded into many shapes. They may be made in factories, restaurants or at home. Noodles (not instant noodles), invented in China at least 2,000 years ago, are made in much the same way. Pastas and traditional noodles are usually eaten as part of dishes often with legumes, nuts and a multitude of vegetables, As such, pastas and noodles, as well as the usual accompanying foods, are classified by the NOVA food system in its first group of unprocessed or minimally processed foods. There is abundant evidence in the scientific literature that healthy diets are those based on a diversity of unprocessed or minimally processed plant foods.

Kate Clancy
Food systems consultant
MISA

There are at least seven factors which combine to define a food as “healthy”. They are pesticide and heavy metal loads, nutrient and phytochemical levels, microbial contamination, antibiotic resistant bacteria, and the overall effect on health of eating particular foods. Research on comparisons between organically produced and conventionally produced foods show positive differences in two elements and no differences for five others. On the positive side, the researchers shown that organically grown produce has significantly lower pesticide residue levels but determining the potential health issues of exposure to dietary pesticides is quite complicated. We do know that there is altered neurodevelopment in children exposed in utero to high concentrations of organophosphate pesticides. Also, the risk of microbial antibiotic resistance is lower in organic animal foods because there are strong restrictions on antibiotic use in their production. There are no significant public health differences between nutrients except vitamin C in the two production systems and the same is true for microbe contamination. Polyphenols – non-nutrient components of food that appear to play a role in lowering the risk of some diseases – are modestly higher in organic foods. Conventional foods have higher concentrations of some heavy metals but there is no difference between the two systems for a number of other heavy metals. Finally, it’s not possible to draw any conclusions yet about the overall effect on health of eating organic foods (for example at this point the relationship between organic food consumption and cancer risk is unclear), because there are many confounders including the fact that people who consume organic foods also exhibit many healthy eating and exercise habits. 

Christina Roberto
Director, PEACH Lab
Assistant Professor of Medical Ethics and Health Policy
PERELMAN SCHOOL OF MEDICINE

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1. Hu FB. Resolved: there is sufficient scientific evidence that decreasing sugar-sweetened beverage consumption will reduce the prevalence of obesity and obesity-related diseases. Obes Rev. 2013;14(8):606-619.

2. Dong D, Bilger M, van Dam RM, Finkelstein EA. Consumption Of Specific Foods And Beverages And Excess Weight Gain Among Children And Adolescents. Health Aff . 2015;34(11):1940-1948.

3. Bernabé E, Vehkalahti MM, Sheiham A, Aromaa A, Suominen AL. Sugar-sweetened beverages and dental caries in adults: a 4-year prospective study. J Dent. 2014;42(8):952-958.

4. Armfield JM, Spencer AJ, Roberts-Thomson KF, Plastow K. Water fluoridation and the association of sugar-sweetened beverage consumption and dental caries in Australian children. Am J Public Health. 2013;103(3):494-500.

5. Nielsen SJ, Popkin BM. Changes in beverage intake between 1977 and 2001. American Journal of Preventive Medicine. 2004;27(3):205-210. doi:10.1016/j.amepre.2004.05.005

Sugar-sweetened beverages are drinks with added sugar (e.g., soda, sports drinks, fruit drinks, energy drinks) and their over consumption is linked with weight gain, type 2 diabetes, and dental caries.1–4 Intake of these drinks increased dramatically since the 1980s,5 and they are now the largest source of added sugar intake in the American diet.6 Sugar-sweetened beverages are consumed at least once per day by half of adults and nearly two-thirds of youth.7 Although sugar-sweetened beverage consumption has declined over time, overall levels remain high.8 Why are these beverages so popular? They are everywhere. They are heavily marketed. They taste good. They come in large portion sizes. And they are cheap, making it hard to give them up. Many people also wrongly believe that certain sugar-sweetened drinks like sports drinks are healthy.9 So if you want to take one concrete step to improve your health, limit the number of sugary drinks you drink each week.

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6. Rosinger, A, Herrick K, Gahche J, Park, S. Sugar-sweetened beverage consumption among U.S. adults 2011-2014. NCHS Data Brief No. 270. Published January 2017. Accessed March 15, 2020.

7. Rosinger A, Herrick K, Gahche J, Park S. Sugar-sweetened beverage consumption among U.S. youth, 2011-2014. NCHS Data Brief No. 271, Centers for Disease Control. Published January 2017. Accessed March 15, 2020.

8. Bleich SN, Vercammen KA, Koma JW, Li Z. Trends in beverage consumption among children and adults, 2003-2014. Obesity . 2018;26(2):432-441.

9. Munsell CR, Harris JL, Sarda V, Schwartz MB. Parents’ beliefs about the healthfulness of sugary drink options: opportunities to address misperceptions. Public Health Nutrition. 2016;19(1):46-54. doi:10.1017/s1368980015000397

Sara Bleich
Professor of Public Health Policy
HARVARD CHAN SCHOOL OF PUBLIC HEALTH

Probably yes. Here is what we know. Eating fast food increases total daily calories, reduces diet quality (since menu items are typically high in fat, salt and sugar), and increases weight gain. And we eat a lot of fast food. On a typical day, one-third of adults and kids in the U.S. eat at fast food restaurants. While many fast food restaurants do provide healthier menu items, the evidence overwhelmingly suggests that eating fast food is not good for your health.

Sharon Palmer
Registered Dietitian Nutritionist (RDN)
THE PLANT POWERED DIETITIAN

Eating more fruits and vegetables is one of the most important things you can do for your overall health—you can boost your diet with nutrients that can help fight a range of chronic disease, as well as keep you feeling vibrant and well. One of the most important ways you can fit more fruits and vegetables into your diet is to make sure you have them on hand. When you do your weekly shopping, try to choose beautiful produce in season. Better yet, go to a farmers market to get unusual seasonal produce straight from harvest. You can’t include these foods in your diet if they aren’t around. Make sure to add a fruit (and maybe even a veg) at breakfast each day by slicing fruit into your morning cereal or smoothie. You can even have a breakfast sandwich or burrito with veggies in it. Next, enjoy fruit is your natural go to snack and even dessert. Include veggies at lunch—don’t skip out, find a way to add a side salad, soup or veggie-rich dish to your lunch meal. At dinner really load up on veggies—include two types of veggies on your plate, and add a soup and/or a salad too. Enjoy more veggie-based meals, such as veggie lasagna, stir-fry, or veggie tacos. Remember, most dietary guidelines recommend that vegetables and fruits make up half of your plate!

Norman R.C. Campbell
Professor Emeritus of Medicine
UNIVERSITY OF CALGARY

Unhealthy diets are the leading risk for death globally, and too much salt is the leading dietary risk. It is estimated that too much dietary salt contributes to over 3 million deaths a year. The average consumption of salt globally is about 10 gm a day. Most people recognize that eating too much salt is bad for their health however, most people also believe they are personally eating the right amount of salt. In part, people do not understand they eat too much salt because salt is put into nearly all foods during processing and the foods often do not taste salty. In industrialized countries about 80% of the dietary salt comes from processed foods including restaurant foods. Breads, processed meats, soups, sandwiches and piazza tend to be major sources of dietary salt even if they do not taste salty. Restaurant and fast foods tend to be high in salt. The best way to avoid salt is to eat fresh foods with little to no added salt. An unprocessed food diet based mainly on a variety of vegetables and fruit tends to be very healthy and has only 1-2 gm of salt a day. Minimize highly salted foods (e.g. pickles), shop for foods with <5% of the daily value for salt (sodium) on the food label, eat less frequently at restaurants and do not add extra salt to your foods in cooking or at the table.

Becky Ramsing
Senior Program Officer, Food Communities & Public Health
JOHNS HOPKINS CENTER FOR A LIVABLE FUTURE

Mindful eating is eating purposefully. It’s about focusing on what you eat, choosing to savor and enjoy and taking time to sit and eat your meals. When we eat mindfully, we tend to choose healthier foods and foods we truly like. We also eat less because we have a better sense when we’ve had enough and are satisfied. Distracted eating, on the other hand, is associated with eating more highly processed, calorically dense and nutritionally poor foods. When we eat quickly and on the run, we don’t sense fullness and have a tendency to overconsume calories.

Christopher Gardner
Rehnborg Farquhar Professor
STANFORD SCHOOL OF MEDICINE

Most of the foods we eat contain carbohydrates, the exceptions are primarily meat and oils. For example, vegetables, beans, grains, fruits, and dairy all contain various amounts and types of carbohydrate that either are made of glucose, or are converted to glucose after being consumed and absorbed. The body works very hard to keep blood levels of glucose in a narrow range, and when it doesn’t the result is a blood glucose level that is too low (hypoglycemia) or too high (hyperglycemia), both of which have negative health consequences. When we eat a mixed diet of whole foods, particularly plant foods that have fiber, the digestion and absorption of glucose occurs slowly and gives the body plenty of time to decide whether to use it right away or store it for later, allowing enough time to store it, and glucose homeostasis is maintained. When high sugar sweets and refined grain breads and snack foods are consumed (i.e., hyperpalatable, ultra-processed), the digestion and absorption of glucose happens so quickly the body often can’t keep up. When blood glucose levels are high, rather than being stored properly, the glucose can bind and attach to cells all around the body in ways that impair the optimal function of those cells (called glycosylation). Optimal health comes from avoiding this rush of glucose into the blood, and avoiding unregulated glycosylation, which can be achieved by eating a whole-food, plant-based diet in amounts that help you maintain a healthy weight.

Marie Spiker
Healthy and Sustainable Food Systems Fellow
ACADEMY OF NUTRITION AND DIETETICS FOUNDATION

Eat vegetables every day, and aim for variety. There is not one type of vegetable you should focus on at the exclusion of others — the power of vegetables comes from “eating the rainbow” (eating a variety of vegetables), rather than focusing on one particular food. There is incredible diversity within the vegetable group, including leafy greens (like lettuce and spinach), cruciferous vegetables (also known as brassicas, like kale, broccoli, and cauliflower), starchy vegetables (like sweet potato and squash), and pulses (like beans and peas). Vegetables are important as a source of fiber, vitamins, minerals, and phytochemicals — the same compounds that give vegetables their taste and vibrant colors also have a variety of health-promoting properties. You don’t need to eat every kind of vegetable every day, but aim for variety as you plan your weekly shopping, cooking, and ordering.

Sophie Egan
Author and founder of Full Table Solutions
FULL TABLE SOLUTIONS

As my colleagues at The Culinary Institute of America and Harvard T.H. Chan School of Public Health have defined “plant-forward” through the Menus of Change initiative, it is: a style of cooking and eating that emphasizes and celebrates, but is not limited to, plant-based foods—including fruits and vegetables (produce); whole grains; beans, legumes (pulses), and soy foods; nuts and seeds; plant oils; and herbs and spices—and that reflects evidence-based principles of health and sustainability. From an eater’s standpoint, the key word is emphasis, as it’s about the overall proportion of the diet that’s made up of “stuff that comes from the ground, So, it’s not about sacrifice or taking foods away or pushing a vegan or vegetarian agenda (though those types of foods, meals, and diets are certainly enjoyed within this umbrella term). More or less synonymous with “plant-rich,” “plant-centric,” and “Flexitarian,” “plant-forward” reflects both the direction I hope the overall restaurant and foodservice industry will take its menu options in the future, and the overall eating pattern I hope the global population will takes its lifelong food choices. The beautiful opportunity is that more and more chefs and scientists agree: it’s the best way to deliciously align optimal nutrition with planetary boundaries.

Becky Ramsing
Senior Program Officer, Food Communities & Public Health
JOHNS HOPKINS CENTER FOR A LIVABLE FUTURE

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Headey, D., Hirvonen, K., & Hoddinott, J. (2018). Animal Sourced Foods and Child Stunting. American Journal of Agricultural Economics, 100(5), 1302-1319. doi:10.1093/ajae/aay053

Despite gains in global nutrition, around 45% of deaths among children under 5 years of age are linked to undernutrition. (WHO) At least 1 in 3 children under 5 – or over 200 million – is either undernourished or overweight, while almost 2 in 3 children between six months and two years of age do not consume food that supports their development. (UNICEF)

Chronic undernutrition early in life is linked to health problems throughout a child’s life, including poor growth and increased susceptibility to infections, as well as chronic diseases later in life. In addition these children are more likely to have poorer achievement in school, earn lower lifetime wages and live in poverty.

Adequate protein intake, including essential amino acids, is crucial for bone and skeletal muscle growth early in life. Even with sufficient caloric intake from staples (grains, starches, etc.), a lack of protein has devastating, long term effects. For young children, the best source of protein and essential amino acids is animal source foods (ASF), especially in settings of low dietary diversity and reliance on staples. Micronutrients associated with growth and cognitive development (B12, choline, zinc) are plentiful in ASF; as is calcium in dairy products. Furthermore, there is a strong association of ASF consumption (especially from multiple sources such as dairy and eggs) and child growth and stature.

Saskia de Pee
Senior Technical Advisor Nutrition
WORLD FOOD PROGRAMME

Vegetables and fruits are a good source of several micronutrients, anti-oxidants, fibre and other components, and they are an important component of a healthy diet. However, for some micronutrients vegetables are not a good source (e.g. vitamin B12, vitamin D) and for some the micronutrient content is good, but it is not easy to absorb (iron, zinc, provitamin A). Therefore, it is recommended to consume in total 400 g of vegetables and fruits per day, and to combine this with foods from several other food groups (staples, pulses, nuts, moderate amount of animal source foods incl fish, eggs, dairy etc). When vegetable intake is lower than recommended, eating more vegetables can improve micronutrient intake, but to a limited extend and not for all required micronutrients.

Bela Gil
Television Chef
BELAGIL.COM

The best answer to this question is: it depends. Fried food could be healthy or unhealthy depending on the type of oil that is used, the temperature of the oil and the frequency that it is consumed. Steamed, sautéed and baked foods with little or no oil are smarter and healthier choices because of the inflammatory nature of fried foods. The best oils to deep fry are the saturated oils because they are more stable in high temperatures and resistant to oxidation and the release of free radicals that triggers inflammation in the body. Examples are: red palm oil, coconut oil, ghee and lard. Another great oil for deep frying is olive oil, which is monounsaturated and packed with antioxidants that protect the oil from becoming rancid during the frying process. Finally, the least recommended oils are the polyunsaturated oils such as corn and soy because they are refined and more prone to oxidation.

Christopher Gardner
Rehnborg Farquhar Professor
STANFORD SCHOOL OF MEDICINE

The law of thermodynamics that supports the concept of your weight, and changes in weight, being a result of the balance of calories in vs. calories out (i.e., eaten vs. expended by physical activity or metabolic activity). If a group of individuals all ate an extra 1000 calories/day, they would all gain weight, and conversely if they all cut back by 1000 calories/day, they would all lose weight. Interestingly, it was proven decades ago that not everyone would gain or lose the same amount of weight even if the calorie increase or decrease was held constant; there is some individual variability involved. Multiple weight loss diet studies have demonstrated that some individuals are likely to be successful with weight loss on just about any diet type (e.g., Low-fat, low-carb, high protein, Mediterranean, Paleo, etc), at least in the short term. But what has also been demonstrated is that there is no one diet that has proven to help all people to be successful with weight loss. The two factors that probably matter the most are satiety, and long-term maintenance. Choosing an eating plan of a set of foods that are generally satiating will help to avoid over-consuming calories. Interestingly, different people find different food combinations more vs. less satiating. If the eating plan is satiating, it will be one that will be more likely to be maintained long-term. If it isn’t sustainable in the long-term, the achieved weight change won’t be maintained. Bottom line is to avoid “going on a diet”, if it means you will eventually “go off the diet”. Choose an eating plan that is enjoyable, satiating, and can be maintained long-term; and if the goal is to lose weight or avoid weight gain, then limit or avoid added sugars or refined grains as these tend to be the least satiating.

Mary Purdy
Registered Dietitian Nutritionist
MARYPURDY.CO

While consuming some saturated fat can be part of an overall healthy diet, the vast majority of scientific research has shown that consuming higher amounts (above 7-10% of total calories in a day) may not be supportive of optimal health. Not only has saturated fat in excess been shown to increase the bad LDL-cholesterol levels which increase the risk of heart disease, (although “good” cholesterol known as HDL may also rise) but it can increase levels of inflammation in the body and may contribute to insulin resistance (a precursor to diabetes) and less healthy weight gain, especially in those who also consume a diet high in refined grains and sugar. From a sustainability perspective, most saturated fat sources come from red meat and dairy products which have a much larger carbon footprint than plant-based foods like beans and nuts. That being said, plant sources of saturated fat aren’t squeaky clean on the sustainability front either. Palm oil production often leads to deforestation of precious land and coconut oil may travel thousands of miles to get into your frying pan. This doesn’t mean a total ban on these foods is necessary, just a sense of mindfulness as you make daily dietary decisions that may affect both human and planetary health. Artificial trans fats from chemically altered oils that are found in a variety of processed foods have been shown in numerous studies to be inflammatory and hazardous to human health. They have been determined/shown to increase risk for heart disease, diabetes, and cancer and are best avoided.

Paul Newnham
Director
SDG2 ADVOCACY HUB

For me, “diverse diets” are those packed with colourful, delicious, biodiverse ingredients. From highly nutritious crops like moringa to climate-smart grain pearl millet, there are 30,000+ edible plant species around the world, each with specific traits that can improve soil health, add nutrients to our diets, build climate resilience and support farmer’s livelihoods. Protecting the diversity of our foods is vital to feeding a growing global population sustainably and yet, we are losing these delicious resources each day. By adding lesser-known ingredients to our plate, we can help shift food systems by encouraging the growth and supply of a more diverse range of crops and safeguarding the health of people and planet.

Raychel Santo
Senior Program Coordinator, Food Production & Public Health, Food Communities & Public Health
JOHNS HOPKINS CENTER FOR A LIVABLE FUTURE

In an ideal world, most of us would rely on minimally processed legumes like dry beans and peas, lentils, and soybeans as key sources of protein in our diets. Diets rich in whole plant foods including legumes have been associated with a reduced risk for many diet-related diseases and have the lowest impact on our planet out of all protein foods available. That said, meat alternatives derived from legumes and other plant-based ingredients can add variety to our diets and make it more convenient to eat plant foods. Meat alternatives range from traditional products that can be used in similar ways as meat (e.g., tempeh, tofu, seitan) to more processed products that are designed to mimic meat (e.g., burgers, fillets, and sausages made from plant protein isolates). It is currently unknown whether these processed products, sometimes referred to as meat analogs, offer nutritional or chronic disease benefits comparable to whole legumes. But we do know that, per every gram of protein, most meat alternatives have a lower planetary impact in terms of greenhouse gas emissions, land and water use, pesticides, and nutrient runoff, compared to conventional meats.

Shu Wen Ng
Distinguished Scholar in Public Health Nutrition
UNC

Excess sugar consumption is a major cause of chronic diseases like dental caries, type 2 diabetes, hypertension, liver and kidney damage, heart disease, obesity and some cancers. Reducing sugar intake is recommended by many international and inter-governmental groups because these chronic disease can start at early ages and become much worse over time without meaningful changes in dietary intake. Children with chronic diseases will struggle to learn and grow properly, individuals with chronic diseases and their caregivers will be unable to work and earn income at their fullest potential and instead incur large out-of-pocket healthcare costs as well as loss in quality of life. At a societal level, when a large and growing share of the population suffer from chronic diseases, the economy will suffer and the healthcare system will not be able to serve all who need its services.

Keith P. West
Program Director, Human Nutrition
JOHNS HOPKINS SCHOOL OF PUBLIC HEALTH

Undernutrition remains a global concern because it is never eradicated, only controlled by assuring all members of societies have access to a safe, adequate, nutritionally balanced diet. Undernutrition can affect humans at any age, be acute and obvious or chronic and even “hidden”, yet impose numerous consequences to health, development, quality of life and survival. Each generation has faced the challenges of preventing hunger, undernutrition and famine. In our day, 800 million to two billion people are undernourished. The good news is that undernutrition is preventable, by producing food that is healthy, sustainable, affordable and accessible to the poor, fortifying stable foods or supplementing diets with essential nutrients, promoting breast feeding, reducing infections, ending conflict and investing in peace.

Marion Nestle
Instructor of Nutrition and Food Studies
NYU

Whole foods have become much easier to define since the term “ultraprocessed” came into use with a fairly clear definition distinguishing them from unprocessed and minimally processed foods. Ultraprocessed foods bear little relationship to the whole foods from which they were derived, are industrially produced, and contain additive ingredients not available in home kitchens or added salt, sugar, and fat. In contrast, whole foods are unprocessed or minimally processed and look a lot like they did when raised, picked, or gathered. These distinctions have important health implications. Frequent consumption of ultraprocessed foods has been linked in observational studies to increased obesity, type 2 diabetes, heart disease, and mortality. One clinical trial demonstrated that ultraprocessed foods encourage excessive calorie consumption and weight gain. Again in contrast, consumption of whole foods is associated with good health as well as with minimal impact on the environment.

Becky Ramsing
Senior Program Officer, Food Communities & Public Health
JOHNS HOPKINS CENTER FOR A LIVABLE FUTURE

A grain of any type – rice, wheat, corn – is made up of three components: the endosperm, bran and germ. A whole grain food product is made with the intact grain kernel, whereas a refined grain product typically contains only the endosperm. While the endosperm of a grain contains carbohydrates and some protein and B-vitamins, the bran and the germ additionally contain fiber, B vitamins, minerals, antioxidants, and even some healthy fats. By choosing whole grains, individuals get the full nutritional and environmental benefit of grains. People who consume more whole grains tend to have healthier weights, lower rates of diabetes, heart disease and cancer.

Erik Oberholtzer
Chef & Co-founder
TENDER GREENS

A balanced meal usually means a combination of fresh fruits and vegetables, complex grains and some animal protein. The specific blend of balance is often debated between stakeholders causing public confusion. For me, Michael Pollan defines it best – “Eat good food, whole food, real food, mostly plants, not too much”. Eating as Pollan suggests supports more than sound nutrition. It supports ingredient diversity important to soil health and ecosystems resilience. Meals built around diverse ingredients deepen our connections to various food cultures and support micro economies around the world. Meals centered on organic heirloom varieties alleviate the pressure on the environment from industrialized food production. As a chef, meals built on fundamentals of fresh, clean, pure flavor simply taste better.

Meera Shekar
Global Lead for nutrition
THE WORLD BANK

Breast-milk is perfectly tailored to a baby’s needs, to an extent that no processed/ultra-processed formula can ever be. Breast-milk is truly better than medicine – the first milk (colostrum) is the baby’s first immunization. WHO recommends that all babies should be exclusively breast-fed (not even water) for the first six months of their lives, following which complementary solid foods need to be added to their diets. Breast-fed babies grow better, have stronger immune systems, in poor environments they are protected from environmental infections thereby reducing the risk of death and diseases, and globally as adults they are less likely to suffer from overweight, obesity and related chronic diseases such as diabetes and cardiovascular diseases. Processed foods have been implicated in many disease etiologies, especially those related to the growing epidemics of cardio-vascular diseases, diabetes, cancers, etc and of course the undernutrition problems in developing countries.  And, even when mothers are undernourished, they can still breast-feed –that’s what motherhood is!

Kate Geagan
Nutritionist and Author
KATEGEAGAN.COM

The best sources of plant-based proteins are those that create extraordinary health in people, are widely accessible and affordable for all eaters, delicious to eat, and sustainable for our planet’s resources. Reams of research point to the power of plant-based protein to deliver high performance nutrition and plenty of protein to meet our body’s needs – making them a vital tool to solve our urgent challenge of how to support healthier people on a thriving planet.

To get the biggest bang for your buck, here’s a trick: focus on minimally processed, whole food options that look similar to how they are found in nature, and opt for packaged food products that list simple to understand, easy to recognize ingredients that sound like you could craft in your own kitchen (instead of highly processed options).

Beans and legumes are longevity and vitality superfoods, delivering heart healthy nutrients such as folate, plus protein (around 15 g per cup) and fiber, a particularly powerful combo that works to keep blood sugar stable, enhance gut health, fight obesity and help ease inflammation. Because of this bounty, in 2016 they were recognized by the UN as being one of the world’s most highly nutritious, affordable and sustainable foods that can also ensure food security. Seeds (such as flax, hemp, chia, sunflower, or pumpkin) deliver roughly 7-9 grams of protein per 1/4 cup and also top the list for good reason: they hold nature’s “essential nutrition blueprint” to start and sustain life, including minerals such as zinc and magnesium, phytonutrients and heart healthy fats. And whole soy foods (such as tofu or edamame), are high-quality complete proteins that contain all 9 essential amino acids in every bite, similar to animal protein.

Nuts (including almond, walnut, cashew and Brazil) deliver 7-9 grams of protein per 1/4 cup, plus are rich sources of key nutrients like omega-3 fats, Vitamin E or selenium. Peanuts in particular have the added benefit of helping replenish our food system by fixing nitrogen back into the soil, reducing the need for fertilizers or agrochemicals (peas are regenerative, too). Ancient supergrains like teff, quinoa and sorghum, and new protein-rich flours like garbanzo bean or almond, are fast reshaping the “inner aisles” of a typical American grocery store, offering super swaps for refined grains and flours in your favorite recipes.

And don’t forget the sea! Seaweed is a nutritional jackpot, boasting impressive amounts of protein (red seaweed has the most, with about 50 grams per 3.5 oz), a bevy of vitamins (A, D and E to name a few), minerals (such as potassium, iodine and magnesium), fiber and more. In addition to promising health benefits such as fighting cancer or supporting our body’s natural detoxification pathways, seaweeds also hold enormous potential to help restore our oceans and create enduring livelihoods for coastal communities.

Andrew Thorne-Lyman
Associate Scientist, Center for Human Nutrition
JOHNS HOPKINS CENTER FOR A LIVABLE FUTURE

In addition to its widely appreciated role as a ‘protein’, animal meat can be an important source of highly bioavailable vitamins, minerals, and fatty acids in the human diet. Differences in the individual components of red meat, poultry, or seafood (particularly in the type of fatty acids, vitamins and minerals) may influence both the risks and benefits associated with its consumption. As no long term randomized trials of diet exist, nutritional epidemiology studies which measure diet over time and relate it to health outcomes, help to guide our understanding of the relative health risks of substituting different types of ‘proteins’.

Research suggests that regular consumption of even small amounts of red meat is associated with an overall greater risk of premature mortality, particularly from heart disease and stroke and that substitution of red meat with poultry, fish, or other protein sources such as beans appears to reduce that risk. Processed red meat may be particularly harmful. Red meat consumption has also been associated with greater risk of certain types of cancer and with diabetes.

Unlike terrestrial meats, for which limited species exist, more than 2000 species of fish and seafood are consumed by humans. The nutritional profile of many of these species is uncertain and influenced by what part of the fish is consumed and how it is prepared. Certain species of fatty fish are rich in long chain omega-3 fatty acids, and in some studies, fish consumption has been associated with reduced risk of cardiovascular disease, neurocognitive benefits, lower risk of preterm birth and better early child development outcomes.

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