Plan Your Plate

diabetes, obesity,

and more. To reach

your goals, experts

advise making small,

gradualchanges.

“The best diet to follow

is one that is science

based, that allows you

to meet your nutritional

requirements, and

that you can stick to in

the long run,” says Dr.

Holly Nicastro, an NIH

nutrition research expert. “It’s not

going to do you any good to follow

adiet that has you eating things that

you don’tlike.”

The main source of science-based

nutrition advice is the Dietary

Guidelines for Americans. These

guidelines describe which nutrients

you need and how much. They

also point out which ones to limit

oravoid.

“Every ﬁve years, an expert panel

reviews all available scientiﬁc

evidence regarding nutrition and

health and uses that to develop the

dietary guidelines,” Nicastroexplains.

The guidelines are regularly

updated, because our scientiﬁc

understanding of what’s healthy

is continuously evolving. These

changes can be confusing, but the

key recommendations have been

consistent over time. In general,

healthy eating means getting a

variety of foods, limiting certain

kinds of carbs and fats, watching

out for salt, and being aware of your

portion sizes.

National Institutes of Health

•

Department of Health and Human Services

•

newsinhealth.nih.gov

What’s the eating style that’s best

for health? Is it a Mediterranean

eating plan? Vegetarian? Low

carb? With all the eating styles out

there, it’s hard to know which one

tofollow.

Healthy eating is one of the best

ways to prevent or delay health

problems. Eating well, along with

getting enough physical activity,

can help you lower your risk of

health problems like heart disease,

Plan Your Plate

Shifting to a Healthy Eating Style

Special Issue

Limit Added Sugars

Added sugar is the extra sugar

added to foods and drinks during

preparation. Corn syrup, high-

fructose corn syrup, brown

sugar, and honey are examples of

sweeteners added to foods and

drinks, especially regular sodas.

“The sugars present normally in

milk and fruit are not considered

added sugar,” explains Dr. Kimber

Stanhope, a nutrition researcher at

the University of California, Davis.

Stanhope’s research focuses on

the eects of added sugar on the

development of disease. Her studies

have shown that consuming too

much high-fructose corn syrup may

increase the risk of weight gain and

heart disease.

The Dietary Guidelines for

Americans suggest a daily limit

on added sugar of no more than

10% of calories. That’s about the

amount in 16 ounces of regular

soda (190calories). You can ﬁnd

information about added sugars

onmost Nutrition Facts labels now.

Plan Your Plate

Shifting to a Healthy

Eating Style

Sweet Stuff

How Sugars and Sweeteners

Affect Your Health

The Skinny on Fat

The Good, the Bad,

and the Unknown

The Salty Stuff

Salt, Blood Pressure, and

Your Health

Rough Up Your Diet

Fit More Fiber Into Your Day

Better Nutrition

EveryDay

How to Choose Healthier

Foods and Drinks

Special Issue

Healthy

Eating

newsinhealth.nih.gov/special-issues

Along with a lot of added salt,

processed foods might have

preservatives, sweeteners,

and other substances added

duringpreparation.

“Stu that comes in a box or

abag that has a whole lot of dierent

ingredients—many of which you

can’t read and understand or

pronounce—those things are highly

processed and generally bad for your

health,” explains Dr. David C. Go,

Jr., a public health expert at NIH.

Make a Meal Plan

“Figuring out what to eat is less

than half the battle,” Nicastro says.

“Sticking to your plan is a bigger

challenge. So that’s why it helps to

bereally prepared and plan ahead.”

You’re much more likely to stick

to your meal plan if you have healthy

food that is ready to go. Some people

ﬁnd it helpful to prepare meals for

the week in advance so that healthy

food is within reach.

The DASH eating plan is a good

start. DASH was developed by

NIH-supported researchers to help

people lower blood pressure without

medicine, but it’s for anyone. Studies

have shown that it reduces the risk

of many diseases.

“The DASH diet is very ﬂexible

because you can follow DASH

without going to a specialty grocery

store. You can follow it with items

that are very familiar to most people

in this country,” Nicastro says.

The DASH eating plan is rich in

fruits, vegetables, whole grains,

beans, seeds, nuts, and ﬁsh.

Compared to the typical American

diet, it’s lower in salt, added sugars,

fats, and red meat. It’s also higher

in ﬁber, potassium, magnesium,

and calcium than the typical

Americandiet.

“Anybody can follow it, despite

speciﬁc preferences or culture,”

Nicastro says. It even works for

people who are vegetarian or only

eat Kosher foods.

“Anybody can improve their diet

by substituting fruits and vegetables

for sugar as their snacks, as part of

their dessert, and as part of their

meals,” says Stanhope. “There

are no advantages of consuming

addedsugar.”

In general, healthy eating

means getting a variety

of foods, limiting certain

kinds of carbs and fats,

watching out for salt,

and being aware of

yourportion sizes.

Consider Your Fats

Fat is high in calories. Getting

too many calories can contribute

to obesity, which raises your risk

for heart disease and other health

problems. But there are dierent

kinds of fats.

Fats that are liquid at room

temperature, or oils, are generally

healthier than those that are solid.

Solid fats are found in high amounts

in beef, chicken, pork, cheese, butter,

and whole milk. Solid fats have more

saturated fats than liquid oils. Liquid

oils—such as canola, corn, olive, or

peanut oil—have mostly unsaturated

or polyunsaturated fats.

The dietary guidelines encourage

consuming liquid oils rather than

solid fats. Nicastro advises that

you examine the fat content on

the Nutrition Facts label. The

label shows how much saturated

fat a product contains. Experts

suggest that you aim for getting

less than 10% of your calories from

saturatedfats.

“For the average person, that’s

going to be less than 20 grams of

saturated fat per day,” Nicastro says.

For example, a small cheeseburger

may have 5 grams of saturated fat,

a typical cheeseburger may have

13, and a double cheeseburger with

bacon may have 24!

Check Labels for Salt

The Nutrition Facts label also shows

salt, or sodium. Experts advise you

to limit salt, which tends to be very

high in processed foods.

If you eat salty, highly processed

food, you can quickly go over the

daily limit of one teaspoon of salt

(2,300 milligrams, or mg, of sodium).

Two hot dogs might have 900 mg of

sodium. A can of ravioli might have

1400 mg. Other examples of salty,

highly processed foods are bacon,

frozen pizzas, and salad dressings.

“Stuff that comes in

abox or a bag that has

a whole lot of different

ingredients—many of

which you can’t read

and understand or

pronounce—those things

are highly processed

and generally bad for

your health.”

NIH News in Health

ISSN 2375-6993 (Print) ISSN 1556-3898 (Online)

Editor Harrison Wein, Ph.D.

Managing Editor Tianna Hicklin, Ph.D.

Graphics Alan Debaugh (illustrations),

Bryan Ewsichek (design)

This special issue is a collection of previously

published articles. However, articles were

updated and re-reviewed by NIH experts

prior to inclusion. Published August 2019.

Use our articles and illustrations in your own

publication. Our material is not copyrighted.

Please acknowledge NIH News in Health as the

source and send us a copy.

newsinhealth.nih.gov

Oce of Communications & Public Liaison

Building 31, Room 5B52

Bethesda, MD 20892-2094

email: nihnewsinhealth@od.nih.gov

phone: 301-451-8224

NIH…Turning Discovery Into Health

newsinhealth.nih.gov/special-issues

Most of us love sweet foods

and drinks. But after that

short burst of sweetness,

you may worry about how

sweets aect your waistline

and your overall health. Is

sugar truly bad for us? How

about artiﬁcial or low-calorie

sweeteners? What have

scientists learned about the

sweet things that most of us

eat and drink every day?

Our bodies need one type

of sugar, called glucose,

to survive. “Glucose is

the number one food

for the brain, and it’s an

extremely important

source of fuel throughout the

body,” says Dr. Kristina Rother,

an NIH pediatrician and expert

onsweeteners.

“Sugar has a bad

reputation that’s mostly

deserved, because we

consume too much of it.

It’s now in just about every

food weeat.”

But there’s no need to add extra

glucose to your diet. Your body can

extract glucose from the sugars

and other carbohydrates in

your food. It can also produce new

glucose, mostly in the liver. That’s

why you can survive for a long time

withouteating.

Some sugars are found naturally

in foods, such as fruits, vegetables,

and milk. “These non-processed

natural foods are healthful additions

to your diet,” says Dr. Andrew

Bremer, a pediatrician and NIH

expert on sweeteners. “When you

eat an orange, for instance, you’re

getting a lot of nutrients and dietary

ﬁber along with the natural sugars.”

Sweet Stuff

How Sugars and Sweeteners Affect Your Health

Although sugar itself isn’t bad,

Rother says, “sugar has a bad

reputation that’s mostly deserved,

because we consume too much of

it. It’s now in just about every food

weeat.”

Added Sugars

Experts agree that Americans eat

and drink way too much sugar,

and it’s contributing to the obesity

epidemic. Much of the sugar we

eat isn’t found naturally in food

but is added during processing

orpreparation.

Sugars are usually added to

make foods and drinks taste better.

But such products can be high in

calories and lack the healthful

You can use the weekly DASH

menus and a form to track your food

and physical activity habits at www.

nhlbi.nih.gov/health-topics/dash-

eating-plan.

Get Expert Advice

The Dietary Guidelines for

Americans are designed to help

people avoid developing obesity,

diabetes, and heart disease. But

everyone is dierent. You may have

needs and risks that aren’t like the

average American. Talk to your

health care provider about your

unique nutritional needs.

“A great resource for someone

to help you with your diet is

aregistered dietitian nutritionist,

orDN,” Nicastro says.

You can ﬁnd this type of expert in

your area by visiting the Academy

of Nutrition and Dietetics at www.

eatright.org/ﬁnd-an-expert.

 Eat a variety of foods—vegetables,

fruits, whole grains, beans, nuts,

seeds, lean meat, seafood, eggs,

milk, yogurt, and cheese.

 Limit foods that are low in

vitamins and minerals.

 Avoid foods with added sugar.

 Replace foods containing

saturated fats (like butter or

lard) with healthier unsaturated

fatoptions.

 Watch out for foods high in salt.

Wise Choices

Make Healthy

DietChoices

For more about healthy eating, go

to: newsinhealth.nih.gov/special-

issues/eating/plan-your-plate

Web Links

Denitions

Glucose

A type of sugar used by the body for

energy. When blood glucose levels get too

high, it can damage tissues and organs

over time.

Carbohydrates

A class of food molecule that includes

sugars, starches, and bers.

newsinhealth.nih.gov/special-issues

back on added sugars. About 15% of

the calories in the American adult

diet now come from added sugars.

Experts recommend a daily limit

onadded sugar of no more than

10% ofcalories.

But added sugars can be hard to

identify. On a list of ingredients,

they may be listed as sucrose

(table sugar), corn sweetener,

high-fructose corn syrup, fruit-juice

concentrates, nectars, raw sugar,

malt syrup, maple syrup, fructose

sweeteners, liquid fructose, honey,

molasses, or anhydrous dextrose.

Added sugar can also be listed

with any word ending in “-ose,” the

chemical sux for sugars. If any

of these words are among the ﬁrst

few ingredients on a food label, the

food is likely high in sugar. To ﬁnd

the total amount of sugar in a food,

look for “Sugars” on the Nutrition

Facts label under the category

“TotalCarbohydrate.”

To nd the total amount

of sugar in a food, look

for “Sugars” on the

Nutrition Facts label

under the category

“Total Carbohydrate.”

Many people try cutting back

on calories by switching from

sugar-sweetened to diet foods and

drinks that contain low- or no-

calorie sweeteners. These artiﬁcial

sweeteners—also known as sugar

substitutes—are many times

sweeter than table sugar, so smaller

amounts can create the same level

ofsweetness.

People have debated the safety of

artiﬁcial sweeteners for decades.

To date, researchers have found no

clear evidence that any artiﬁcial

sweeteners approved for use in the

U.S. cause cancer or other serious

health problems like birth defects

inhumans.

But can they help with weight

loss? The scientiﬁc evidence is

beneﬁts of fruits and other naturally

sweetfoods.

Sugar-sweetened beverages like

soda, energy drinks, and sports

drinks are the leading source of

added sugars in the American diet.

Juices naturally contain a lot of

sugar. But sometimes, even more is

added to make them taste sweeter.

“Juices oer some vitamins and

other nutrients, but in general,

Ithink those beneﬁts are greatly

oset by the harmful eects of too

much sugar,” Bremer says.

Over time, excess sweeteners

can take a toll on your health.

“Several studies have found

a direct link between excess

sugar consumption and obesity

and cardiovascular problems

worldwide,” Bremer explains.

Cutting Back

Because of these harmful eects,

many health organizations

recommend that Americans cut

mixed. Some studies suggest that

diet drinks can help you drop pounds

in the short term. But their long-

term eects on weight—and other

health aspects—are unclear. Rother

and other NIH-funded researchers

are now working to better

understand the complex eects that

artiﬁcial sweeteners may have on

the human body.

Studies of rodents and small

numbers of people suggest that

artiﬁcial sweeteners can aect

thegut microbes that help us digest

food. This in turn can alter the

body’s ability to use glucose, which

might then lead to weight gain. But

until further studies are done in

people, the long-term impact of these

sweeteners on gut microbes and

weight remains uncertain.

Beyond the Gut

“There’s much controversy about

the health eects of artiﬁcial

sweeteners and the dierences

between sugars and sweeteners,”

says Dr. Ivan de Araujo at the Mount

Sinai Icahn School of Medicine.

“Some animal studies indicate

that sweeteners can produce

physiological eects. But depending

on what kind of measurement is

taken, including in humans, the

outcomes may be conﬂicting.”

The key to good health

is eating a well-balanced

diet with a variety of foods

and getting plenty of

physical activity.

De Araujo and others have been

studying the eects that sugars and

low-calorie sweeteners might have

on the brain. They are ﬁnding that

sugar and sweeteners tap dierently

into the brain’s reward circuitry,

with sugars having a more powerful

and pleasurable eect.

“The part of the brain that

mediates the ‘I can’t stop’ kinds of

 Choose water, milk, or unsweet-

ened tea or coee instead of

sodas, sports drinks, energy

drinks, and fruit drinks.

 Reduce sugar in recipes. If a recipe

says 1 cup, use 2/3 cup.

 To enhance avor, add vanilla,

cinnamon, or nutmeg.

 Eat fresh, canned, frozen, and

dried fruits without added sugar.

Choose fruits canned in their own

juice or water rather than syrup.

 Use fruits to top foods like cereal

and pancakes rather than sugars,

syrups, or other sweet toppings.

 Read the ingredients list to pick

food with little or no added sugar.

 Use the Nutrition Facts label to

choose packaged foods with

lesssugars.

Wise Choices

Cut Added Sugars

newsinhealth.nih.gov/special-issues

For more about sugar and

sweeteners, go to: newsinhealth.

nih.gov/special-issues/eating/

sweet-stu

Web Links

Fat is an essential nutrient for

our bodies. It provides energy.

It helps our guts absorb certain

vitamins from foods. But

what types of fat should you

be eating? Are there any you

shouldavoid?

Recommendations about

dietary fat have shifted

over the last two decades.

From the 1970s through the

1990s, nutrition researchers

emphasized eating a low-fatdiet.

This was largely because

of concerns about saturated

fats, explains Dr. Alice H.

Lichtenstein, who studies diet and

heart health at Tufts University.

Saturated fat that’s in the

bloodstream raises the levels of LDL

cholesterol—the “bad” cholesterol.

This in turn raises the risk of

heartdisease.

But when people started following

low-fat diets, they didn’t only cut

saturated fats. In many cases, they

replaced healthy unsaturated

fats with processed carbohydrates,

explains Lichtenstein.

“Initially, when we recommended

cutting total fat, we did not

anticipate people would replace it

with fat-free foods, like cookies,

crackers, and ice cream, made with

reﬁned grains and sugar,’” says

Lichtenstein. “It is what we refer to

as an unanticipated consequence.”

As scientists have learned, those

replacement calories matter. Studies

have shown that replacing saturated

fat with unsaturated fat reduces

the risk of heart disease. However,

replacing saturated fat with simple

carbohydrates, such as added sugar

and white bread, does not.

“There’s still this misconception

that eating fat—any kind of fat—is

bad, that it will lead to heart attacks

or weight gain. That’s not true.

People really should be encouraged

to eat healthy fats,” says Dr.

The Skinny on Fat

The Good, the Bad, and the Unknown

Frank Sacks, a nutrition expert at

HarvardUniversity.

Healthy Fats

Research has shown that

unsaturated fats are good for you.

These fats come mostly from plant

sources. Cooking oils that are liquid

at room temperature, such as canola,

peanut, saower, soybean, and olive

oil, contain mostly unsaturated fat.

Nuts, seeds, and avocados are also

good sources. Fatty ﬁsh—such as

salmon, sardines, and herring—are

rich in unsaturated fats, too.

Large studies have found that

replacing saturated fats in your diet

with unsaturated fats can reduce

your risk of heart disease by about

the same amount as cholesterol-

lowering drugs.

behaviors seems to be especially

sensitive to sugars and largely

insensitive to artiﬁcial sweeteners,”

de Araujo says. “Our long-term

goal is really to understand if

sugars or caloric sweeteners drive

persistent intake of food. If exposed

to too much sugar, does the brain

eventually change in ways that lead

to excess consumption? That’s what

we’d like to know.”

Some research suggests that the

intensely sweet taste of artiﬁcial,

low-calorie sweeteners can lead to

a “sweet tooth,” or a preference for

sweet things. This in turn might

lead to overeating. But more studies

are needed to conﬁrm the relative

eects of caloric versus non-caloric

sweeteners.

Don’t Sugarcoat It

“In the long run, if you want to

lose weight, you need to establish

a healthy lifestyle that contains

unprocessed foods, moderate

calories, and more exercise,”

Rothersays.

When kids grow up eating a lot of

sweet foods, they tend to develop a

preference for sweets. But if you give

them a variety of healthy foods like

fruits and vegetables early in life,

they’ll develop a liking for them, too.

“It’s important for parents to

expose children to a variety of tastes

early on but realize that it often

takes several attempts to get a child

to eat such foods,” Bremer says.

“Don’t give up too soon.”

The key to good health is eating

awell-balanced diet with a variety of

foods and getting plenty of physical

activity. Focus on nutrition-rich

whole foods without added sugars.

Get tips on healthy eating and weight

control at go.usa.gov/xEjmc.

Denitions

Saturated Fats

Fats that are solid at room temperature;

found in butter, lard, full-fat milk and

yogurt, full-fat cheese, and high-fat meat.

Unsaturated Fats

Fats that tend to be liquid at room

temperature; found in vegetable oils,

seafood, and nuts.

newsinhealth.nih.gov/special-issues

People should actively make

unsaturated fats a part of their diet,

Sacks says. You don’t need to avoid

healthy fats to lose weight, he adds.

In an NIH-funded study Sacks

led, called the POUNDS LOST trial,

people who ate higher-fat or lower-

fat diets had similar rates of weight

loss. They were also both successful

at keeping the weight o.

“Low-fat diets have the same

eect on body weight gain or

weight loss as higher-fat diets or

higher-protein diets,” he explains.

“For weight loss, it’s about getting

ahandle on whatever foods in your

diet are giving you excess calories.”

Replacing “Bad” Fats

So are there fats you should avoid?

Only a few years ago, doctors still

had to advise people to avoid

so-called trans fats in their diets.

These largely manufactured

fats could be found in things like

margarine and many processed

foods. They have been shown to

raise the risk ofheartdisease.

Since 2015, the U.S. Food and

Drug Administration has taken

steps to remove artiﬁcial trans fats

from the food supply. Most trans fats

now in food come from the small

amounts found naturally in animal

products, like meat and butter.

Experts already recommend that

people limit their intake of animal

fats. “So that takes care of those

trans fats as well,” Lichtenstein says.

As for saturated fat, it’s

complicated. Not all of the saturated

fat in the bloodstream comes

from the saturated fat that we eat,

explains Dr. Ronald Krauss, who

studies cholesterol at the UCSF

Benio Children’s Hospital Oakland.

Instead, it’s produced when the body

breaks down simple carbohydrates

and sugars. That’s one reason why

replacing saturated fat in the diet

with simple carbohydrates doesn’t

reduce the risk of heart disease.

Nutrition experts still recommend

that people minimize the amount

of saturated fat in the diet. But

researchers are now looking at

whether the type of food that

saturated fat is found in matters.

For example, the inﬂuence of plant-

based saturated fats, such as those in

coconut and palm oil, is still unclear

and being researched further.

Recent studies suggest that some

full-fat dairy products, such as

yogurt, may actually have beneﬁts

for the heart, Krauss says.

Krauss and his colleagues recently

ran a small study looking at the

eects of replacing some of the

sugar allowed in the DASH diet with

saturated dairy fats. The DASH diet

was developed by NIH to help lower

blood pressure.

Participants who ate saturated

dairy fat instead of sugar had less

of a fat called triglycerides in their

bloodstream. The higher-fat diet

was also as eective at lowering

blood pressure as the standard

DASH diet.

More research is needed to

understand which foods that contain

saturated fats may inﬂuence the

body in a good way.

Individual Needs

Researchers know that there are big

dierences in how people’s bodies

react to dierent types and amounts

of fat. But they still don’t know why.

Studies have found that genes aren’t

likely responsible, Sacksexplains.

Lichtenstein and Krauss are both

studying how the microbes that live

in the gut interact with dietary fats.

The makeup of the microbiome—all

the microorganisms that normally

live in the body, mainly in the gut—

can dier widely between people.

It may turn out that dierent types

of gut bacteria produce dierent

compounds from fats. These

compounds could then aect the

body in dierent ways, Lichtenstein

explains. Or dierent types of

fats could promote the growth of

dierent bacteria in the gut, which

may then have varying eects

onhealth.

“We just don’t know yet, but there

is tremendous interest in trying

to understand the role of the gut

microbiome in human health,”

shesays.

If there’s one thing that the

research has shown, it’s that the

science of diets is very complex.

Experts have moved away from

focusing on single nutrients—such

as fat—by themselves. Instead, Sacks

says, researchers now talk about

healthy dietary patterns: ways of

eating that take all aspects of the

diet into account. Learn more about

healthy dietary patterns at health.

gov/dietaryguidelines.

 Eat plant-based foods. Plants can

contain healthy fats, as well as

important vitamins and minerals.

 Include plant oils in your diet.

Healthy choices include canola,

peanut, olive, saower, soybean,

sunower, corn, and nut oils.

 Replace foods containing

saturated fats (like butter or

lard) with healthier unsaturated

fatoptions.

 Limit fatty red meat. Instead, eat

more sh, poultry, or lean meats.

 Reduce sugars and replace

processed grains, such as white

bread and white rice, with whole

grains and brown rice. The body

can use simple carbohydrates to

make saturated fats.

Wise Choices

Choosing Fats

For more about dietary fat, go to:

newsinhealth.nih.gov/special-

issues/eating/skinny-fat

Web Links

newsinhealth.nih.gov/special-issues

The Salty Stuff

Salt, Blood Pressure, and Your Health

pressure below.

Some research also suggests

that excessive sodium intake

increases the risk of stomach cancer.

Scientists continue to investigate

this possible connection.

Researchers do know that not

everyone is equally sensitive to salt.

“From our experiments, we know

there’s lots of variation in the blood

pressure response to sodium intake,”

Nicastro says. Certain groups of

people see greater reductions in

blood pressure when they lower their

salt intake: African-Americans,

older adults, and people with blood

pressure above normal.

“Within those groups, there’s

alot of variation between people,”

Nicastro says. But about 1 in 3 adults

nationwide has high blood pressure

right now. Another third have

elevated blood pressure, meaning

their numbers are high enough to

put them at risk to develop high

Salt is essential to our body’s ﬂuids.

That’s likely why we evolved to enjoy

its taste. On the other hand, anyone

who’s gotten a mouth full of seawater

knows that too much salt tastes

terrible. Maybe your body’s trying to

tell you something. It turns out that

too much salt can lead to ahost of

health problems.

Dietary salt, or table salt, is

made from two chemical elements:

sodium and chloride. That’s why its

chemical name is sodium chloride.

It’s the sodium part that’s been tied

to health problems. But since most of

the sodium we ingest is from salt, it’s

dicult to separate the eects of salt

and sodium in many studies.

Health Effects

“The best-known eect of sodium on

health is the relationship between

sodium and blood pressure,”

explains Dr. Holly Nicastro, an NIH

nutrition research expert. Dozens of

studies, in both animals and people,

have linked a higher salt intake with

higher blood pressure. Reducing salt

intake, on the other hand, lowers

blood pressure.

Blood pressure is the force of

blood pushing against the walls of

arteries as the heart pumps out

blood. When this pressure rises—a

condition called high blood pressure,

or hypertension—it can damage

the body in many ways over time.

High blood pressure has been linked

to heart disease, stroke, kidney

failure, and other health problems.

There are two blood pressure

numbers, and they’re usually

written with one above or before

the other. Systolic, the ﬁrst, is the

pressure when the heart beats,

pumping blood through the arteries.

Diastolic is the pressure when the

heart is at rest between beats. The

numbers 120/80mmHg are the ones

you should aim to keep your blood

blood pressure. In light of this, she

says, “It’s really important for the

majority of U.S. adults to reduce

their blood pressure.”

How Much Salt?

Experts recommend that adults take

in less than 2,300 milligrams (mg) of

sodium a day—that’s what’s in about

6 grams of salt, or about a teaspoon.

People with high blood pressure

Denitions

Arteries

The vessels that carry blood from your

heart throughout your body.

Stroke

When normal blood ow to the brain is

stopped, usually by ruptured or blocked

blood vessels.

newsinhealth.nih.gov/special-issues

from a decline in heart disease, and

younger adults from fewer deaths.

Reducing Salt

Some countries have tried to lower

salt intake using various strategies,

such as working with industry to

reduce the salt content in processed

foods, requiring labels on ready-to-

eat foods, and educating the public.

The UK achieved a 15% reduction in

salt consumption between 2003 and

2011. During this time, deaths from

stroke fell by 42% and from heart

disease by 40%.

But wouldn’t we miss the taste?

“Several studies have shown that as

you gradually reduce sodium intake,

you lessen your desire for salty food,”

Nicastro says. And surveys of people

across the UK found that most

people didn’t notice any dierence in

the taste of their food.

“A very modest decrease in the

amount of salt, hardly detectable

in the taste of food, can have

dramatic health beneﬁts for the

U.S.,” Bibbins-Domingo stresses.

The salt we add to our food

actually accounts for about 10%

of our salt consumption. Most of

the salt we eat comes in processed

foods from stores, restaurants, and

dining halls. You may already know

that fast food, cold cuts, and canned

foods tend to have a lot of salt.

“Many people don’t realize that

a lot of our salt is from breads and

cereals,” Bibbins-Domingo says.

Studies have found that about 15 to

20% of the sodium in the average

American’s diet comes from grain

products, such as breads, cereals,

crackers, and chips.

“In terms of advice, I think the

best guidance we have is for people

to pay attention to nutrition facts

on the labels,” Nicastro says. “The

percent daily value is a better guide

than the language that’s used on food

labels like ‘low-salt.’ These labels

can be confusing, because they have

very deﬁned technical meanings.”

should shoot for 1,500 mg. But right

now, American adults eat an average

of about 3,600 mg of sodium per day.

Dr. Kirsten Bibbins-Domingo

at the University of California,

San Francisco, led an NIH-funded

study that used computer modeling

to explore the eects of a modest

reduction in salt intake in the United

States. The researchers found that

reducing salt intake by 3 grams per

day (1,200 mg of sodium) could cut

the number of new cases of heart

disease each year by as many as

120,000, stroke by 66,000, and heart

attack by nearly 100,000. It could

also prevent up to 92,000 deaths

each year.

All segments of the population

would beneﬁt, with African-

Americans having the greatest

improvements overall. Women

would particularly beneﬁt from

reductions in stroke, older adults

Try to select foods, she advises, with

less than 5% of the daily value of salt

per serving.

“In terms of advice, I think

the best guidance we

have is for people to pay

attention to nutrition facts

on the labels.”

Making Changes

Even small salt reductions can aect

your blood pressure. If you can’t ﬁnd

a low-salt alternative to aparticular

food, it still helps to pick something

that’s lower than what you’re already

consuming.

“You can ﬁnd remarkable

variation in the amount of salt

across major brands of food,”

Bibbins-Domingo says. “Even

without choosing something labeled

‘low sodium,’ you can often ﬁnd a

lower-sodium alternative.”

Beyond salt, a healthy eating

plan can help keep your blood

pressure under control. Check out

NIH’s Dietary Approaches to Stop

Hypertension (DASH) eating plan

at go.usa.gov/xEjmy. Other lifestyle

measures can help you keep your

blood pressure down, too. Lose

weight if you’re overweight or obese.

Get regular physical activity. Quit

smoking. Manage your stress. The

more of these steps you take, the

more likely you’ll be to avoid related

health problems.

Why not start now? Make small

changes at ﬁrst, and then keep

working to gradually lower your

family’s salt intake.

For more about salt, go to:

newsinhealth.nih.gov/special-

issues/eating/salty-stu

Web Links

 Look at Nutrition Facts labels and

try to choose prepared foods that

have less than 5% of the Daily Value

of sodium per serving.

 Use fresh poultry, sh, and lean

meat, rather than canned, smoked,

or processed.

 Choose fresh or frozen vegetables

that have no added salt.

 Rinse canned foods to remove

some of the sodium.

 Add less salt—or none—when

cooking.

 Use reduced-sodium bouillon,

dressings, and sauces like soy sauce.

 Use fresh herbs and buy spices and

blends without added salt.

 Cook at home instead of eating out,

when possible. But when eating

out, ask that no extra salt be added

to your food.

Wise Choices

Cut Back on Sodium

newsinhealth.nih.gov/special-issues

Rough Up Your Diet

Fit More Fiber Into Your Day

labels. Many foods

contain both. And

both types have health

beneﬁts. Experts

suggest that men aim

for about 38 grams

of ﬁber a day, and

women about 25grams.

Unfortunately, in the

United States, we

take in an average of

only 16grams of ﬁber

eachday.

Health Benets

Some of ﬁber’s greatest

beneﬁts are related

to cardiovascular

health. Several large

studies have found that

people who eat the most

ﬁber had alower risk

for heartdisease.

“You might think that if

it’s not digestible then it’s

of no value. But there’s

no question that higher

intake of ber from all

food sources is benecial.”

High ﬁber intake—particularly

soluble ﬁber—seems to protect

against several heart-related

problems. “There is evidence that

high dietary ﬁber consumption

lowers ‘bad’ cholesterol

concentrations in the blood and

reduces the risk for developing

heart disease, stroke, and high blood

pressure,” says Dr. Somdat Mahabir,

a nutrition and disease expert with

NIH’s National Cancer Institute.

Fiber can help relieve constipation

and normalize your bowel

movements. Insoluble ﬁber is often

used to treat or prevent constipation

and diverticular disease, which

Fiber—you know it’s good for you.

But if you’re like many Americans,

you don’t get enough. In fact, most of

us get about half the recommended

amount of ﬁber each day.

Dietary ﬁber is found in the plants

you eat, including fruits, vegetables,

and whole grains. It’s sometimes

called bulk or roughage. You’ve

probably heard that it can help

with digestion. So it may seem odd

that ﬁber is a substance that your

body can’t digest. Much of it passes

through your digestive system

practically unchanged.

“You might think that if it’s not

digestible, then it’s of no value.

But there’s no question that higher

intake of ﬁber from all food sources

is beneﬁcial,” says Dr. Joanne Slavin,

a nutrition scientist at the University

of Minnesota.

Types of Fiber

Dierent types of ﬁber can aect

your health in dierent ways. That’s

why the Nutrition Facts labels on

some foods may list two categories

ofﬁber: soluble and insoluble.

Soluble ﬁber is found in oats, beans,

peas, and most fruits. Insoluble

ﬁber is found in wheat bran and

somevegetables.

Some soluble ﬁber is broken

down by the complex community

of bacteria and other microbes

that live in the human gut. These

microbes, called gut ﬂora or

microbiota, help with our digestion.

Emerging research shows they can

aect our health in various ways.

Studies suggest that they may play

a role in obesity, type 2 diabetes,

colon cancer, and other conditions.

Researchers are now looking at

how dierent types of dietary ﬁbers

aect the gut microbiota—and how

that, in turn, aects our health.

But soluble and insoluble ﬁber

aren’t always listed separated on

aects the large intestine, or colon.

Fiber may also play a role in

reducing the risk for type 2 diabetes,

the most common form of diabetes.

Fiber in the intestines can slow

the absorption of sugar, which

helps prevent blood sugar from

spiking. “With diabetes, it’s good to

keep glucose levels from peaking

too much,” explains Dr. Gertraud

Denitions

Cardiovascular

The system of heart and vessels that

circulates blood through the body.

Cholesterol

A waxy, fat-like substance that your body

needs to function. However, a high level

in the blood is a major risk factor for

heartdisease.

Type 2 Diabetes

A disease in which blood levels of

glucose—a type of sugar—are too high.

newsinhealth.nih.gov/special-issues

and keep your weight in check.

Your weight is another area

where ﬁber might help. High-ﬁber

foods generally make you feel

fuller for longer. Fiber adds bulk

but few calories. “In studies where

people are put on dierent types

of diets, those on the high-ﬁber

diets typically eat about 10% fewer

calories,” Slavin says. Other large

studies have found that people with

high ﬁber intake tend to weigh

less—although that may be because

their diets are healthier.

Scientists have also looked into

links between ﬁber and dierent

types of cancer, with mixed results.

For example, there is evidence that

a high intake of dietary ﬁber may

reduce the risk for colon cancer and

colon polyps.

A Fiber-Rich Diet

Experts say that the type of ﬁber

you eat is less important than

making sure you get enough overall.

“In general, people should not

be too concerned by the speciﬁc

type of ﬁber,” Mahabir says. “The

focus should be more on eating

diets that are rich in whole grains,

legumes, beans, vegetables, fruits,

nuts, and seeds to get the daily

ﬁberrequirement.”

Whole grains, fruits, and

vegetables are also packed with

vitamins and other nutrients, so

experts recommend that you get

most of your ﬁber from these natural

sources. “Unfortunately, a lot of

people tend to pick low-ﬁber foods.

They go for white bread or white

rice. Most of the processed

foods—foods that are really

convenient—tend to be low in ﬁber,”

says Slavin.

For people who have trouble

getting enough ﬁber from natural

sources, store shelves are ﬁlled

with packaged foods that tout

added ﬁber. These ﬁber-fortiﬁed

products include yogurts, ice cream,

cereals, snack bars, and juices. They

Maskarinec of the University

ofHawaii.

In an NIH-funded study,

Maskarinec and her colleagues

followed more than 75,000 adults

for 14 years. Consistent with other

large studies, their research found

that diabetes risk was signiﬁcantly

reduced in people who had the

highest ﬁber intake.

“We found that it’s mostly the

ﬁber from grains that protects

against diabetes,” Maskarinec

says. However, she notes that while

high ﬁber intake may oer some

protection, the best way to reduce

your risk of diabetes is to exercise

For more about ﬁber and health, go

to: newsinhealth.nih.gov/special-

issues/eating/rough-up-your-diet

Web Links

 Bulk up your breakfast. Choose a

high-ber cereal (5 or more grams

per serving) or make a bowl of

oatmeal and top it with nuts and

fruit.

 Switch to whole grains. Look for

bread that lists whole-grain our

as the rst ingredient. Experiment

with barley; wild or brown rice;

quinoa; whole wheat pasta;

andbulgur.

 Add a non-starchy vegetable.

Keep a bag of frozen mixed

vegetables, spinach, or broccoli

orets for a quick addition to any

pasta sauce or rice dish. Start

dinners with a tossed salad.

 Don’t forget legumes. Try peas,

dierent kinds of beans (pinto,

kidney, lima, navy, and garbanzo),

and lentils.

 Snack on fruit, nuts, and seeds.

Grab a piece of fruit such as an

apple, pear, or banana. Keep some

almonds, sunower seeds, and

pistachios handy. Low-fat popcorn

or sliced vegetables and hummus

also make a great snack.

Wise Choices

Tips to Get More

Fiber in Your Diet

generally contain isolated soluble

ﬁbers, such as inulin, polydextrose,

or maltodextrin. These isolated

ﬁbers are included in the product

label’s list of ingredients.

However, the health beneﬁts of

isolated ﬁbers are unclear. Research

suggests they may not have the same

eects as the intact ﬁbers found in

whole foods. For instance, there’s

little evidence that isolated ﬁbers

help lower blood cholesterol. They’ve

also shown inconsistent eects on

the regularity of bowel movements.

On the plus side, some studies

suggest they might boost the growth

of good bacteria in the gut.

“The focus should be