Living a Healthy Life with Chronic Pain (32 page)

• Choose foods as nature originally made
  or removed (often fiber or nutrients) to make
  them.
  This means the less processed the bet-them tastier. Examples include whole grains ter. By
  processed
  we mean foods that have made into white flour for bakery products or been changed from their original state by hav-animal foods made into deli meats. Choosing ingredients added (often sugar, salt, or fat) ing the least-processed option isn’t difficult.
  Go for a grilled chicken breast instead of fried breaded chicken nuggets, a baked potato (with skin) rather than French fries, and whole-grain bread and brown rice instead of white bread and white rice.
  

• Get your nutrients from food, not supplements.
  For most people, vitamin, mineral, and other dietary supplements cannot completely take the place of food. Unprocessed foods contain nutrients and other healthy compounds (such as fiber) in the right combinations and amounts. When manufacturers remove nutrients from their natural state in food, the foods may not fuel your body the way they should.
     For instance, take beta-carotene, an important source of vitamin A, found in plant foods such as carrots and winter squash. It helps our vision and enhances our immune system. However, artificial beta-carotene supplements have been shown in some people to increase some cancer risks. This same risk is not present when beta-carotene is eaten as it is naturally found in food. Another reason to get your nutrition from foods as close as possible to how nature made them is that these choices could contain as yet unknown healthy compounds. When you take a supplement such as a vitamin pill, you could be missing out on many other helpful substances that are naturally packaged with the food from which the vitamin was removed.
     In many countries, including the United States, there are no government-imposed quality controls for diet and nutrition supplements. Unlike over-the-counter medications, with supplements there is no guarantee you are getting what you pay for or that you are not getting harmful substances. In Canada, many vitamin and mineral supplements and “natural” health products are licensed by Health Canada. Health Canada assesses these products to be sure they are safe, effective, and of high quality. You can check if a product is licensed in Canada by going to the Licensed Natural Health Products Database of Health Canada. The web address is listed under Other Resources at the end of this chapter.
     Can dietary supplements ever play a role in healthy eating? Yes—sometimes we cannot get enough of one or more of the nutrients we need. Vitamin D is an example. People who live in more northern climates can have low levels of vitamin D. In Canada, Health Canada advises everyone over the age of 50 to take a daily supplement of atleast 400 IU of vitamin D. Another example is calcium. Older men and women need a large amount of calcium to help prevent or slow osteoporosis. Although you should aim to get enough calcium from milk and milk products such as yogurt or cheese, it may be difficult to get the necessary amount. If you are thinking of taking supplements, it is important to talk to your health care professional or a registered dietitian first.
  

• Eat a wide variety of colorful minimally processed foods.
  Your goal is to get more variety, more colors, and fewer processed foods on your plate. These three simple rules will give your body all the good things it needs. Choose minimally processed meat, fish, or poultry and a lot of colorful fruits and vegetables.
  Think blue and purple for grapes and blueberries; yellow and orange for pineapple, oranges, and carrots; red for tomatoes, strawberries, and watermelon; and green for spinach, kale, and green beans. Don’t forget the white and warm brown tones from mushrooms, onions, and cauliflower and whole grains such as brown rice.
  

• Eat foods high in phytochemicals.
  Phytochemicals are compounds that are found only in plant foods—fruits, vegetables, whole grains, nuts, and seeds (
  phyto
  means “plant”). There are hundreds of health-promoting and disease-fighting phytochemicals. These include compounds that give fruits and vegetables their bright colors. Whenever a food is refined or processed, as when whole wheat is made into white flour, phytochemicals are lost. The more often you choose foods that are not refined, and as close as possible to how nature made them, the better.
  

• Eat regularly.
  A gas-fueled vehicle will not run without the gas, and a fire eventually burns out without more wood. Your body is much the same. It needs refueling regularly to work at its best. Eating something, even a little bit, at regular intervals helps keep your “fire” burning.
     Eat at regular times during the day, preferably at evenly spaced intervals during the day. This helps maintain and balance your blood sugar level. Blood sugar is a key player in supplying the body, especially the brain, with energy. If you do not eat regularly, your blood sugar drops. If it becomes too low, it can cause weakness, sweating, shaking, mood changes (irritability, anxiety, or anger, for example), nausea, headaches, or poor coordination. This can be dangerous for many people.
     Eating regularly helps you get the nutrients you need and helps your body process those nutrients. Not skipping meals or not letting too many hours go between meals also helps keep you from getting overly hungry. Being overly hungry often leads to overeating. This can in turn lead to such problems as indigestion, heartburn, and weight gain. You may find that sometimes several small meals throughout the day works well while at other times fewer, bigger meals work best. So eating regularly does not mean you must stick to the same routine every day. Nor does it mean you must follow the “normal” pattern of eating three meals a day. Allow yourself room for give and take.
  

• Eat what your body nedes
  (not more or less). This is easy to say but more difficult to put into action. How much you should eat depends on things like the following:
  

• Stop eating when you first feel full
  . This helps you control the amount you eat so you don’t overeat. Pay attention to your body so you can learn what fullness feels like. Like all new skills, it takes some practice. If it is hard to stop eating when you begin to feel full, remove your plate or get up from the table if you can.
  

• Eat slowly
  . Eating slowly gives you more enjoyment and helps prevent overeating. Make your meals last at least 15 to 20 minutes. It takes that long for the brain to catch up and tell your stomach that it is getting full. Put down your utensils between bites. If you finish quickly, wait at least 15 minutes before getting more food. If this is difficult for you, see the additional tips on
  pages 222
  –
  225
  .
  

• Be mindful of what you eat
  . If you are not paying attention to what you are doing, it is easy to eat an entire bag of chips or cookies or eat too much of any bite-sized pieces of food without even knowing it. This can happen easily when we are with friends, using the computer, or watching television. In these situations, try portioning out what you want to eat before you begin eating, or keep food out of reach or out of sight. Don’t eat right out of the package—place food in an appropriate serving-sized container. Take time to enjoy what you are eating.
  

• Know a serving size when you see one
  . To do this, you need to know what a serving size or portion looks like. A 1/2-cup (125 mL) portion is about the size of a tennis ball or a closed fist. A 3-ounce (84 g) portion of cooked meat, fish, or poultry is about the size of a deck of playing cards or the palm of your hand. The end of your thumb to the first joint is about one teaspoon (5 mL); three times that is a tablespoon (15 mL).(Tip: Use a measuring spoon or cup to see what a serving size looks like.)
  

• Watch out for supersizing and portion inflation
  . In recent years, serving sizes at restaurants and in packaged foods have literally “beefed up.” The typical adult cheeseburger used to have about 330 calories; now
  it has a whopping 590 calories. Twenty years ago, an average cookie was about 1½ inches (3.8 cm) wide and had 55 calories; now it is 3½ inches (8.9 cm) wide and has 275 calories—
  five times
  the calories! Soda typically came in 6½-ounce (195 mL) bottles with 85 calories; today a typical bottle of soda is 20 ounces (600 mL) and 250 calories.
     If we consume 3,500 calories more than we need, we gain a pound of body fat. Over a single year, consuming just an extra 100 calories a day will cause you to put on 10 pounds (4 kg). That is equal to eating only an extra third of a bagel each day! There are many published ranges of recommended serving sizes for different foods. In the food guide on
  pages 226
  –
  233
  , we list some common serving sizes for a variety of foods.
  

• When practical, select single-size portions
  . Foods that are prepackaged as single servings can help you see what a suggested serving should look like.
  

• Make your food attractive
  . We really do eat with our eyes! Compare the appeal of a plate of white rice, white cauliflower, and white fish with one of baked sweet potato, bright green spinach, and grilled white fish with salsa. Which of these two meals seems more appetizing?
  

The U.S. Department of Agriculture’s MyPlate Map for Healthy Eating in
Figure 13.1
shows what a healthy meal should look like. Put your meal together so that one-fourth of the plate is covered with colorful fruit, one-fourth with vegetables, one-fourth with a protein source (lean meat, fish, or poultry, or better yet, plant foods such as tofu, cooked dry beans, or lentils), and the remaining one-fourth with grains (preferably at least half from whole grains) or other starches such as potatoes, rice, yams, or winter squash. Finish off your plate with calcium-rich foods. These could be milk or foods made from milk (preferably fat-free or low-fat), such as cheese, yogurt, frozen yogurt, puddings, or calcium-fortified soy foods such as soy milk. Of course, your food choices and amounts will depend on what you like and need. If you would like more information about this way of eating, check out the USDA’s MyPlate website at
www.choosemyplate.gov
.

Even with this map as a guide, calories and portion sizes are important. Plate sizes are now larger, making it easier to get more calories than you need.
Table 13.1
on
page 214
can help you as you plan. It gives you examples of recommended daily portions from different food groups. Note that these amounts are general recommendations and may be different if you have special dietary needs. If you have questions, check with your doctor or a registered dietitian.

Figure 13.1
MyPlate: A Map for Healthy Eating

Note, too, that when you go to the Internet for information and recommendations, you will find many people who say they are nutrition experts. They may not be. If you want a real expert, look for a registered dietitian (RD). These health professionals are specially trained and are the best sources for diet and nutrition advice and information.

Earlier we talked about the benefit of getting nutrients from food not from supplements. In the following sections, we talk about carbohydrates, fats, protein, a few vitamins and minerals, and plain old water. Although it is technically not a nutrient, we also talk about fiber.

First, take a look at
Table 13.1
on
page 214
, Daily Recommended Servings, with Examples for Healthy Meal Planning. It lists the number of recommended servings for adult women and men along with examples of serving sizes. These recommendations are for people who do less than 30 minutes of moderate exercise a day and eat 1,000 to 3,000 calories. If you have a special health problem or condition, such as diabetes, you may need to change how much you eat of certain foods. Even so, you can still follow the Map for Healthy Eating.
Table 13.2
on
page 226
provides more detailed information about the nutritional values per serving size of many common foods. Use both
Table 13.1
and
13.2
to help you with healthy meal planning.

With few exceptions, carbohydrates are your body’s go-to fuel for the brain, central nervous system, and red blood cells. Carbohydrates largely determine your blood sugar level—more so than protein or fat. And carbohydrates do a great deal more. They provide the basic materials for the vital components in your body. The construction of nearly every part of your body, from your toenails to the top of your head, involves carbohydrates. These include hormones, fats, cholesterol, and even some vitamins and proteins.

Carbohydrates are found mostly in plant foods such as grains, starchy vegetables, and fruits. Milk and yogurt are about the only animal foods that have more than a very small amount of carbohydrate. Sugary carbohydrates are found in fruit and juice, milk, yogurt, table sugar, honey, jellies, syrups, and sugar-sweetened drinks. Starchy carbohydrates are found in vegetables such as corn, green peas, potatoes, winter squash, dried beans and peas, lentils, and grains such as rice. Pasta, tortillas, and bread are high in starchy carbohydrates. The amount of carbohydrate in whole grains, brown rice, and whole-wheat bread is similar to that in refined grains, such as white bread and white rice. The big difference between whole grain foods and refined foods is that the refined grains have lost nutrients, phytochemicals, and fiber, and other important compounds during processing.

Fiber is found naturally in whole and minimally processed plant foods with “skins, seeds, and strings.” For example, whole grains, dried beans, peas, lentils, fruits, vegetables, nuts, and seeds all have some fiber. Some foods have added fiber (as when pulp is added to juice). Animal foods and refined and processed foods (white flour, bread, many baked and snack foods) have little or no fiber unless it was added by the manufacturer.

Fiber helps you in important ways. The fiber in wheat bran, some fruits and vegetables, and whole grains keeps your digestive system moving and helps prevent constipation. The fiber in oat bran, barley, nuts, seeds, beans, apples, citrus fruits, and carrots can help manage your blood sugar because it slows the amount of time it takes for sugar to get into the bloodstream. It can also help lower blood cholesterol. High-fiber diets are also thought to help reduce the risk of rectal and colon cancers.

Not all fat is bad for you. You need some fat for survival and for your body to work properly. Your body needs about one tablespoon (15 mL) of fat a day to work properly.

Although all fats have the same number of calories per portion, some fats are more healthful than others, and some can be harmful when we eat too much.

Good fats (also called unsaturated fats) are oils that are usually liquid at room temperature. They help keep your cells healthy, and some can help reduce blood cholesterol. Good fats include soybean, safflower, corn, peanut, sunflower, canola, and olive oils. Nuts, seeds, and olives (and their oils), as well as avocados, are also rich in good fats.

Omega-3s are another group of good fats that can reduce the risk of heart disease and may help with some types of chronic pain symptoms. (They may, for example, reduce inflammation.) These fats are found in fatty fish such as salmon, mackerel, sardines, arctic char, trout, and tuna. Other sources of omega-3s include wheat germ, flaxseed, and walnuts, although the body may not use omega-3s from plants as well as it does the omega-3s from fish.

The bad fats (also called saturated fats) are usually solid at room temperature (think shortening, butter, lard, and bacon grease). They can increase blood cholesterol and the risk of heart disease. Most bad fats are found in animal products such as butter, beef fat, chicken fat, and pork fat (lard).
Other foods high in bad fats include stick margarines, red meat, regular ground meat, processed meats (sausage, bacon, deli meats), poultry skin, whole- and low-fat milk, sour cream, and cheese (including cream cheese). Palm kernel oil, coconut oil, and cocoa butter are also considered bad fats because they are high in saturated fat. However, research is being done on some possible health benefits of coconut oil.

The fats classed as “deadly” are the trans fats. They can increase blood cholesterol and risk of heart disease even more than the bad fats. Trans fats are in many processed foods, including pastries, cakes, cookies, crackers, icing, margarine, and most microwave popcorn. The best strategy is to eat as little trans fats as possible. They are listed on food labels as “partially hydrogenated” or “hydrogenated” oils. Be warned! Food companies can legally claim “no” or “0” trans fats on the label even when the food has up to half a gram (0.5 g) per serving. There are no specific daily recommendations for how much fat you should eat. Most people get more than enough in their diet. The best recommendation is to eat very little bad and deadly fats. Replace bad and deadly fats with good fats, but do not increase the total amount of fat you eat.

There is one more thing you should know about fat. All fats contain twice the calories per teaspoon as protein or carbohydrates. Calories from fat add up quickly. For instance, one teaspoon (5 mL) of sugar has about 20 calories, but the same amount of oil or solid fat has about 35 calories. When we eat more calories than we need—no matter where they come from—the extra calories get stored as body fat, which leads to weight gain.

Protein is vital for hundreds of biological processes that keep you alive and healthy. Protein is part of your muscles, red blood cells, and the enzymes and hormones that help regulate the body. Protein helps your immune system fight infection and builds and repairs damaged tissues. It can also give you some energy. But like fat, protein is not as good a source of energy for the body as carbohydrates.

There are two types of proteins: complete and incomplete. Complete proteins have all the right parts in the right amounts. Your body uses them just as they are. Complete proteins are found in animal foods—meat, fish, poultry, eggs, milk, and other dairy products—as well as in soy foods such as soybeans, tofu, and tempeh. Incomplete proteins are low in one or more parts. They are found in plant foods such as grains, dried beans and peas, lentils, nuts, and seeds. Most fruits and vegetables contain little, if any, protein. For your body to be able to use incomplete proteins best, eat them with at least one other incomplete protein or along with a complete protein. Two of the most commonly eaten incomplete protein pairs are beans and rice and peanut butter and bread.

Nearly all plant proteins are incomplete proteins, yet they are at the heart of eating healthy. By eating a small amount of an animal protein such as chicken with a plant food such as lentils or black beans, you get all the benefits of a complete protein. In addition, some plant foods, such as nuts and seeds, are sources of the good fats, and many plant foods are good sources of fiber. Plant foods have no cholesterol and little to no trans fats.

Table 13.1
Daily Recommended Amounts, with Examples for Healthy Meal Planning

These recommendations are for average adults (19 years and older) who exercise less than 30 minutes daily and eat 1,000 to 3,000 calories. They are based on the United States Dietary Guidelines. (For Canada’s guidelines, please see
www.healthcanada.gc.ca/foodguide
.)

If you have a special condition, you may need to modify portion sizes of certain foods but should still aim for an overall balance.