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When you have a bacterial infection, you get an antibiotic. When you want to give up smoking, you get a nicotine patch. If you could do something to lower your risk of cancer, heart disease or other serious ailments, why wouldn't you do it?
Because you might not like the prescription: Lots of fruits and vegetables. Fish. Milk. Limited amounts of red meat. And plenty of exercise.
The list of "good" foods and "bad" foods seems to change from week to week, which can make us want to throw up our hands and say fine, I'll eat whatever I want.
But in fact, for some common life-threatening diseases, the link to diet is strong and well-documented.
Here's a look at four such diseases: cancer, heart disease, diabetes and osteoporosis. In each case, the right dietary choices can at least minimize the risk of developing the condition, if not outright prevent it.
We talked to the experts and capsulized the latest advice into a handy stay-healthy guide.
A few generalities emerged: There are no magic foods. And the diets they propound are strikingly similar, even as research continues.
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CANCER
- Overall
For the majority of Americans who don't smoke, eating a healthful diet and being physically active can reduce cancer risks, according to the American Cancer Society.
Evidence suggests one-third of the 550,000 cancer deaths that occur in the United States each year are due to unhealthy diet and lack of physical activity.
The American Institute for Cancer Research recommends a mostly plant-based diet of fruits, vegetables, whole grains and legumes, with a reduced emphasis on meat.
A diet low in fat that includes a wide variety of at least five servings of fruits and vegetables daily can decrease overall incidence of cancer by 20 percent, according to the institute. The case is even stronger with colorectal cancer, where the main causes are believed to be diet and related factors, though much more is known about colon than about rectal cancer, according to the American Institute for Cancer Research.
Research suggests up to half of colorectal cancers could be prevented by diets high in vegetables and low in fat. Colon and rectal cancers are not the same, but usually are categorized together.
Eating vegetables in a rainbow of colors provides the best arsenal of protective phytochemicals. When choosing salad greens, remember the darkest greens are the most nutritious and may provide the best protection.
-Food choices
Kale is high in phytochemicals, antioxidants and dietary fiber. Sweet potatoes are an excellent source of beta carotene and fiber. Berries, such as strawberries, blueberries and raspberries, are high in antioxidants, vitamin C and fiber. Whole grains, such as whole-wheat bread and oatmeal, provide more benefits than refined grains, such as white rice and white spaghetti. Legumes of all types are an excellent substitute for red meat; a couple servings of fish each week provide protective Omega-3 fatty acids. Eat no more than 3 ounces of red meat daily.
-Lifestyle
If grilling, cut down on carcinogens that can form when meat is grilled by marinating it first, placing it farther from the flame and turning it frequently. A better idea? Grill vegetables, which do not form carcinogens.
Exercise regularly. "More is better than less; some is better than none," said Melanie Polk, a registered dietitian and institute's director of nutrition education.
The American Cancer Society recommends, as a minimum, that adults engage in at least moderate activity for 30 minutes or more five or more days of the week. Physical activity works in a variety of ways to reduce risk, including helping to control weight and influencing hormones, the society says.
Recent strong and consistent evidence suggests regular physical activity protects against colon cancer.
-Research to watch
Breast cancer strikes more than 200,000 women a year and kills more than 40,000. Milk may have a protective effect in the fight against breast cancer, according to a recent study co-funded by the National Cancer Institute and the Norwegian Cancer Society. The study suggested that women who drank milk as a child and who drink at least three glasses of milk a day had half the rate of breast cancer compared with women who drink little or no milk.
Recent research on ovarian cancer suggests a plant-based diet may help in its prevention.
-Resources
The American Cancer Society offers a comprehensive Web site (www.cancer.org) or call (800) 227-2345 for more information. The American Institute for Cancer Research also offers detailed information on the latest research at its Web site (www.aicr.org) or call (800) 843-8114.
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HEART DISEASE
-Overall
The No. 1 killer of Americans, and a key cause of disability, is heart disease, stroke and other cardiovascular diseases.
Heart disease alone is the No. 1 killer and stroke is the No. 3. About 62 million Americans live with cardiovascular diseases, according to the American Heart Association.
Cardiovascular diseases cost Americans more than any other disease - a projected $352 billion in medical expenses and lost productivity this year.
Artery-clogging cholesterol is the most widely publicized culprit in increasing the risk of cardiovascular disease and 42 million Americans have high cholesterol levels, the association reports.
Dietary cholesterol - found in foods such as eggs and red meat - should be limited to no more than 300mg per day for the average person and less than 200 mg for people at risk.
The heart association recommends eating lots of fruits and vegetables, which are good sources of vitamins, minerals and fiber, but have few calories, little fat or sodium and no cholesterol.
The association three years ago placed a new focus on an overall dietary pattern. The recommendations are: at least five servings of fruits and vegetables daily; six or more servings of whole grains and beans; a varied diet including the major food groups; and at least two servings of fatty fish, such as tuna or salmon.
The association recommends a diet moderate in sugar, because of the link to high consumption of sweets to obesity.
-Food choices
Fish, once again, gets the nod as a healthful choice, and especially fatty tuna or salmon, rich in Omega-3 fatty acids, which combat cardiovascular disease. During the past 10 years, epidemiological studies have found an association between fish consumption and a decreased risk of coronary heart disease deaths and sudden death in healthy men and in those with cardiac heart disease.
Foods high in soluble fiber, such as oat bran, oatmeal, beans, peas, rice bran, barley, citrus fruits, strawberries and apple pulp get a nod for their protective benefits in helping to lower blood cholesterol.
Limit eggs to no more than three egg yolks per week.
Choose from all fresh, frozen, canned or dried vegetables and fruits, except coconut, which is high in saturated fat. Count olives and avocados as fats.
-Lifestyle
A greater emphasis is placed on exercise in combination with diet, compared with three years ago, when the role of exercise was a mere mention.
At least 30 minutes of daily aerobic activity, such as brisk walking, is recommended. Maintaining a healthy weight is also recommended.
-Research to watch
Scientists are studying the genetic predictability of diseases and eventually hope to be able to tailor diets to individual patients.
-Resources
The American Heart Association's Web site offers information on advocacy, research and family support. Or call (800) 242-8721.
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DIABETES
-Overall
About 17 million people in the United States, or 6.2 percent of the population, have diabetes, according to the American Diabetes Association. An estimated 11.1 million have been diagnosed; about 5.9 million are unaware they have the disease.
The best dietary advice in the quest to fend off diabetes is simply this: Lose weight if you're overweight and follow a diet that permits you to maintain a healthy weight.
Being overweight, along with family history, are the biggest risk factors for diabetes. It's also important to stay physically active - "We are really trying diligently not to separate those two," said Marian Benz, a registered dietitian and certified diabetes educator in Milwaukee.
The concern about being overweight extends to children, who are exhibiting in adolescence a whole new type of diabetes, Benz said - not type 1 (insulin-dependent, previously known as juvenile diabetes) or type 2 (non-insulin dependent).
Children's Hospital of Wisconsin works with more than 1,000 type 1 children in its diabetes education program and now has about 100 with this new type, called maturity-onset diabetes of youth.
While much is yet unknown, it is believed that this form of diabetes is caused by excess weight and ought to be preventable through proper diet and weight control.
-Food choices
No specific foods act as magic pills. In general, people need to teach themselves to make food selections from all of the food groups, emphasizing fruits, vegetables and whole grains and cutting back on serving sizes of high-sugar or high-fat treats; in other words, the same healthy diet prescribed for the general population.
Moderation is key. "For example, if you like high-sugar foods, teach yourself that it's OK to have these things occasionally" but not all the time or in huge portions, Benz said. "Even people with diabetes are allowed to have 10 percent of their carbohydrate calories to come from sucrose."
Sugar consumption in and of itself, she said, does not cause diabetes. The problem is the fat that often comes with foods high in sugar, which can lead to weight gain.
-Lifestyle
Exercise, stay fit and eat three meals a day - including breakfast. Skipping meals can lead to habitual snacking, another behavior that packs on the pounds.
-Research to watch
More news about the glycemic index, which measures how quickly carbohydrates are digested and rush into the bloodstream as sugar. Proponents of this new and deeply controversial approach, which rates specific foods as high, moderate or low on the index, say too many "high" - or fast-digesting - foods cause people to be hungry again too soon, therefore causing them to overeat. So far, both the American Diabetes Association and the American Heart Association dismiss the idea.
-Resources
The American Diabetes Association Web site (www.diabetes.org) contains a wealth of information, including brochures that can be downloaded. Those without Internet access can call the association at (888) 342-2383 for referrals or mailings. Another resource: www.eatright.org, the Web site of the American Dietetic Association.
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OSTEOPOROSIS
-Overall
About 10 million people (four in five of them women) are estimated to have osteoporosis. It is responsible for more than 1.5 million fractures annually, according to the National Osteoporosis Foundation.
The dietary prescription for reducing this risk is simple and well-documented: a high intake of calcium, protein and vitamin D. Calcium and protein each make up about half the volume of bone; by weight, protein is about one-third, said Robert P. Heaney, professor of medicine at Creighton University in Omaha, Neb., who has been working in the bone field since 1955.
In one recent study, the lowest rate of bone loss was found in women with the highest protein intake and vice-versa. There was a fourfold difference.
"We focus on calcium because it is the nutrient more likely to be deficient in the American diet," Heaney said. "(However,) my suspicion is that a substantial fraction of the American population today (also) does not get enough protein."
Throughout our lives, bones are constantly changing, or "remodeling," to adapt to changing uses and demands or to make repairs.
Bones can recycle stored calcium and phosphorus but not protein.
"So we need a fresh supply of dietary protein every day," Heaney said.
Meat and plant protein are equally effective.
The third key nutrient, vitamin D, is needed to absorb an adequate amount of calcium.
"What people don't realize is how prevalent vitamin D deficiency is in North America," Heaney said.
A 1998 study of 290 patients admitted to Massachusetts General Hospital's medical service found 57 percent to be deficient in vitamin D. By current standards subscribed to by researchers, Heaney said, it would be more like 85 percent.
Vitamin D is added to milk, and "a couple of boutique yogurts may have it added. (Otherwise), unless you eat a lot of fish oil, or get plenty of sun exposure, you aren't going to get enough" and supplements may be necessary, he said.
Specific recommendations for this trio of nutrients are:
Calcium: The RDA differs by age and gender, from 800 to 1,500 milligrams a day, but those are really "the least you can get by on," according to Heaney. He advises everyone from adolescence on up to consume from 1,200 to 1,500mg each day.
Vitamin D: The latest official recommendations, from 1997, call for 200 International Units a day to age 50; 400IU to age 70; and 600IU after 70.
"If we knew then what we know now, they would be much higher numbers," said Heaney, who added that he routinely prescribes 1,000 units per day.
Protein: 0.8 grams per kilogram of body weight. (Multiply your weight in pounds by 0.45 to find your weight in kilograms.) By this measure, a weight of 150 pounds calls for a diet with 54g of protein daily. Some expert believe this isn't high enough, Heaney said.
-Foods choices
Milk and yogurt are the best food sources of calcium (assuming no lactose-intolerance), and it's better to get calcium from food, Heaney said. "In our studies, we look at hundreds of women, and those with low calcium intake tend to be low in at least four other important nutrients as well. You won't easily fix that with a pill."
Legumes and meat, fish, poultry and some dairy products such as cheese are all sources of protein.
-Lifestyle
Activity is vital. "Our bones are like muscles - use it or lose it. ... We can feel it in our muscles ... we can't feel it with our bones, but the same thing is happening," Heaney said. So-called "impact loading" is best - running, jogging, jumping rope.
"Swimming is very good cardiovascular exercise, but it doesn't do anything for bone health," he said. "Running is better than bicycling."
Jumping rope, he said, "has a stronger effect on building bone mass around the hip than anything else."
-Research to watch
Bone health is a very active research field, Heaney said. One study to be released in a month reconceptualizes osteoporosis as too much bone remodeling as opposed to too little bone mass.
While it isn't really new information, and it won't affect dietary recommendations, "it helps us rethink abut how things are working and how we get into trouble."
-Resources
National Osteoporosis Foundation, www.nof.org. NOF Information Center: (800) 223-9994. National Resource Center, National Institutes of Health Osteoporosis and Bone Diseases: www.osteo.org.
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RECIPES
Start your disease-fighting diet today with the following recipes, all from "The Wellness Kitchen" (Rebus Inc., $34.95), a new book by the staff of The Wellness Kitchen and the editors of the University of California-Berkeley Wellness Letter. The first recipe is quick, simple and a good source of Omega-3 fatty acids, selenium, vitamin B12 and vitamin D.
SHRIMP SCAMPI
1 tablespoon olive oil
5 cloves garlic, minced
1 1/2 pounds large shrimp, shelled and deveined
3/4 teaspoon salt
1/3 cup chopped parsley
3/4 teaspoon grated lemon zest
1/4 cup fresh lemon juice
In large non-stick skillet, heat oil over medium-high heat. Add garlic and cook 1 minute. Add shrimp and salt. Cook until shrimp are not quite opaque throughout, about 2 minutes. Add parsley and lemon zest, and cook 1 minute. Add juice, swirling to combine. Makes 4 servings.
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This side dish or appetizer features the leek. It is a good source of fiber, folate, magnesium, potassium, vitamin B6 and vitamin C.
BRAISED LEEKS WITH TOMATOES AND CORIANDER
6 medium leeks (2 pounds total), roots removed and dark green ends trimmed
1 can (14.5 ounces) diced tomatoes
1 teaspoon grated orange zest
1/3 cup orange juice
2 teaspoons olive oil
2 garlic cloves, minced
1/4 teaspoon ground coriander
1/4 teaspoon salt
6 Gaeta or kalamata olives, pitted and coarsely chopped
2 tablespoons chopped cilantro
Halve leeks lengthwise. Soak in bowl of warm water, gently pulling back top several inches of layers to get dirt that lodges where leeks start to turn green. Use several changes of warm water until there's no grit remaining in bottom of bowl. Lift leeks out of water and pat dry.
In large non-stick skillet, combine tomatoes, orange zest, orange juice, oil, garlic, coriander and salt. Bring to boil over medium heat. Add leeks, cover and cook until fork-tender, turning them occasionally, about 15 minutes. Stir in olives and cilantro. Serve warm, at room temperature or chilled. Makes 4 servings.
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(c) 2003, Milwaukee Journal Sentinel. Distributed by Knight Ridder/Tribune News Service.
