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Plant-forward diets are increasing in popularity across much of the Western world; data suggest that the number of US consumers eating entirely plant-based diets grew from nearly four million in 2014 to 19.6 million in 2017. A national Harris Poll in 2016 indicated that more than 3% of Americans are vegetarian, with more than half of that group identifying as vegan. Multiple motivations are driving this trend: improving animal welfare, lessening our environmental footprint, reducing disease risk and improving illness outcomes, etc. As a dietitian, I aim to help patients and the public who follow meatless diets (or diets devoid of all animal products) get nutrients through other foods or supplements and ensure their well-being. How are vegetarianism and veganism defined? Both vegetarian and vegan diets are considered “plant-forward.” Vegetarian diets consist primarily of plant-based foods and exclude animal flesh, but they may or may not include products originating from animals, such as eggs and milk. Vegan diets include no animal products whatsoever. Cosmetics, processed foods, medications and various consumer goods may include ingredients derived from animals, making them inappropriate for a vegan diet. A few examples include: Gelatin, which comes from cows’ or pigs’ connective tissue and is used as a thickener in various foods, vitamins and cosmetics Animal rennet, which is extracted from calves’ stomachs and used in many types of cheese Lactose, which comes from milk and is used in various medications Carmine, which is derived from crushed insects and used to color various foods, cosmetics and personal care products Packaging may not be labeled clearly or accurately, so consumers must use their discretion to avoid these products and/or choose plant-based alternatives. Individuals following plant-based diets may also classify foods and other consumer goods—those that contain ingredients or components such as honey or leather, for instance—differently depending on their compliance with a specific dietary pattern. What are the benefits of following a plant-forward diet? Overall dietary quality, as assessed by the Healthy Eating Index and Mediterranean Diet Score, is better among those following vegetarian diets. Following a vegetarian or vegan diet has been associated with myriad beneficial health outcomes, including: Weight loss and/or maintenance Lower blood pressure Lower blood cholesterol Lower body mass index (BMI) Reduced risk of and improved outcomes from cardiovascular disease Reduced risk of colon, prostate, breast and other cancers Reduced risk of and enhanced outcomes from diabetes Improved gut microbiome (which is associated with health benefits throughout the body) What are the potential health risks of following a plant-forward diet? The benefits described above have been proven through observational and experimental studies for many years. However, there are some risks of following a plant-forward diet if it isn’t planned and implemented thoughtfully—potentially leading to nutritional deficiencies, disordered eating patterns and/or even impaired relationships and social engagements. People are often concerned about protein; indeed, vegetarians and vegans have fewer options for protein sources in their diets, and the protein in plant-based foods is less bioavailable. However, by consuming protein sources throughout the day and increasing portions slightly to compensate for lower digestibility, vegetarians and vegans can still meet their bodies’ needs for all essential amino acids (the building blocks that comprise protein molecules) and overall protein quantity. (Note that most healthy adults are recommended to have 0.8 grams of protein per kilogram of body weight per day: roughly 46 grams for the average woman and 56 grams for the average man.) Several vitamins and minerals are found primarily or entirely in animal-based foods. Indeed, results from a 2021 systematic review in Clinical Nutrition showed that veganism is associated with deficiencies in several micronutrients but that low micro- and macronutrient intakes are not always associated with poor health. However, some of the studies reviewed suggested that vegans may have an increased risk of mental health issues, hematological disorders and other deficiency-related conditions. Considerations for these essential nutrients are shown in the table below. Several groups of people may need additional guidance on dietary strategies and/or supplementation, and some may be advised against following a vegetarian/vegan diet (depending on their individual needs and medical histories). Examples of these groups may include: Malnourished patients (especially those who are elderly) who struggle to consume enough nutrient-dense foods, Patients with a history of an eating disorder or disordered eating patterns, Young children (especially those who may be underweight), Women who are pregnant or breastfeeding (and therefore have elevated nutrient needs), Patients with diseases directly related to deficiencies of nutrients found primarily in animal-based foods (such as megaloblastic anemia or osteoporosis), and/or Patients experiencing food insecurity or living in drought-prone areas with limited access to nutrient-dense vegetarian foods (and who might otherwise need to rely mainly on refined grains). How can vegetarians and vegans ensure they meet their needs? People following (or interested in following) one of these plant-forward diets should consider the following recommendations to ensure they meet their nutrient needs and are optimally healthy: Continue to follow a balanced plate model to ensure all food groups are included in meals. Include vegetarian protein sources and healthy sources of fat—along with fruits, vegetables and whole grains—to be fully satiated and nourished. Keep in mind nutrient pairings (such as iron and vitamin C) and food preparation methods (such as cooking in cast iron pans) that can help to maximize absorption and bioavailability to meet your body’s needs. Plan ahead when eating out or sharing meals with omnivorous family and friends so that you ensure you will have options to eat; this might mean eating before attending an event, asking if a restaurant can make vegetarian substitutions and/or contributing a dish that you know you can eat and others will also enjoy. If you wish to reduce your diet’s environmental footprint but don’t want to (or can’t) follow an entirely plant-based diet, consider reducing your portion sizes and/or the frequency with which you eat animal products; also aim to buy sustainably raised and locally grown meat, seafood and dairy products. Talk with a dietitian about your individual nutrient needs and assess whether your diet (or intended diet) meets those needs and how to modify accordingly; also talk with a doctor and/or dietitian to consider whether supplements may be warranted. For additional resources about vegetarian diets representing diverse cultures, tips for meeting nutrient needs, recipe ideas and meal plans, visit: Oldways Vegetarian Resource Group Vegetarian Nutrition Dietetic Practice Group Resources Bakaloudia DR, Hallorran A, Rippin HL, et al. Intake and adequacy of the vegan diet. A systematic review of the evidence.Clinical Nutrition. 2021; 40(5):3503-3521. sciencedirect.com/science/article/pii/S0261561420306567 Clarys P, Deriemaeker P, Huybrechts I, Hebbelinck M, Mullie P. Dietary pattern analysis: a comparison between matched vegetarian and omnivorous subjects.Nutrition Journal. 2013;12:82. d-nb.info/109871735X/34 Melina V, Craig Q, Levin S. Position of the Academy of Nutrition and Dietetics: Vegetarian Diets.JAND. 2016; 116(12): P1970-1980. jandonline.org/article/S2212-2672(16)31192-3/fulltext Stahler C. How often do Americans eat vegetarian meals? And how many adults in the US are vegetarian? The Vegetarian Resource Group. 2016. vrg.org/nutshell/Polls/2016_adults_veg.htm The Vegan Society Statistics. Accessed February 15, 2022. vegansociety.com/news/media/statistics Christina Badaracco, MPH, RD Christina is a registered dietitian and author who aims to improve access to healthy and sustainable food and educate Americans about the connections between food and health. She loves to experiment with healthy recipes in the kitchen and share her creations to inspire others to cook. Christina completed her dietetic internship at Massachusetts General Hospital and earned her Master of Public Health degree from the University of California, Berkeley. Previously, she graduated with a degree in Ecology and Evolutionary Biology from Princeton University, after conducting her thesis on sustainable agriculture and energy in Kenya. She has done clinical nutrition research at the National Institutes of Health, menu planning and nutrition education at the Oakland Unified School District and communications at the Environmental Protection Agency's Office of Water. She has also enjoyed contributing to children’s gardens, farmers markets and a number of organic farms. cbadarac@gmail.com www.linkedin.com/in/christina-badaracco/

These brain healthy biscotti are amazing. Full of chocolate and lots of flavor. If you want to treat yourself to something delicious and brain healthy, then this is the recipe for you! Double Chocolate and Pistachio Biscotti Ingredients: 2 cups almond flour plus more for dusting ¾ cup natural cacao powder ¾ teaspoon baking powder ¾ teaspoon baking soda ½ teaspoon kosher salt 3 large eggs at room temperature ¾ cup coconut palm sugar 1 teaspoon pure vanilla extract 1 teaspoon almond extract 1 cup raw pistachios toasted (see Note) ½ cup dark chocolate chips For the glaze: ½ cup dark chocolate chips 1 teaspoon extra virgin olive oil Instructions: •Preheat the oven to 375ºF with a rack set in the center position. Line a rimmed baking sheet with parchment paper or a silicone mat. •In a medium bowl, whisk together the flour, cacao powder, baking powder, baking soda, and salt. In a large mixing bowl or the bowl of a standing mixer, beat together the eggs, sugar, and vanilla and almond extracts. Gradually add the dry ingredients until no streaks of flour remain. Fold in the nuts and ½ cup chocolate chips until evenly distributed. •Dust your work surface with flour and divide the dough into two equal balls. The dough will be sticky so dust your hands with flour, too. Flatten each half of dough out into a rectangular log that is 10 inches long, 2 ½ inches wide, and 1 inch tall. Transfer the logs to the baking sheet, reshape if needed, and bake until the dough is lightly browned, with cracks on the surface, and springy to the touch, 20 to 25 minutes. Set aside until completely cool, about 15 to 30 minutes depending on the temperature of your kitchen. Reduce the oven temperature to 300ºF. •Carefully transfer the logs to a cutting board. Use a serrated knife to slice the cookies straight up and down, about ½-inch thick. Transfer the cookie slices back to the baking sheet and place them standing up. (You can crowd all the cookies onto the same pan or use an additional baking sheet.) Bake until the biscotti are dry to the touch and no longer springy, 25 to 35 minutes. •While the biscotti cool, make the chocolate glaze. Place the chocolate chips in a heat-proof bowl over a small pot of boiling water, making sure the water doesn’t touch the bottom of the bowl. When the chocolate is melted, whisk in the olive oil until you have a smooth glaze. Drizzle over the cooled biscotti and let sit until the glaze has set. •To store, keep in an airtight container for up to 3 weeks.

This Granola recipe is simply delicious and full of lots of healthy nuts and seeds. It is devoid of oil. I've been making this granola every week and I eat it with yogurt and a seasonal fruit for breakfast everyday! Granola Ingredients: 6 cups organic old-fashioned rolled oats 1 cup raw pumpkin seeds, hulled 1 cup unsweetened coconut chips (Trader Joe's) 1 cup raw pecan halves ¼ cup hemp seeds (you can also add chia or flax seeds) 2 tsp cinnamon (add more if you like cinnamon) ¾ cup pure maple syrup ½ tsp sea salt ½ - ¾ cups of coarsely chopped raw almonds Directions: •Preheat the oven to 350 degrees •Line 2 rimmed cookie sheets with parchment paper. •In big bowl, mix ingredients (minus the almonds). Mix well. •Pour onto the baking sheets making sure it’s in an even and thin layer otherwise it won’t get crisp. •Bake 30-45 minutes. Turn every 10 min until crisp and toasted. •When the granola is almost done (you will know when everything becomes a golden brown), take the pans out of the oven, do not stir, add the chopped almonds and sprinkle about 1 TB maple syrup on the top of the granola. Cook for an additional 2 minutes. This helps make the granola extra crunchy! •Allow to completely cool before moving the granola to a glass storage container.

You’ve probably heard about omega-3 fats—the healthy fats we should include in our diets—when reading about health or browsing the aisles at the grocery store. However, did you know that there are different types of omega-3 fats? And did you know that omega-3 fats benefit a broad array of body systems, not just the heart and brain? Read on to learn more about this essential fat. What are omega-3 fats? Omega-3 fats are an important kind of fat that people obtain almost solely through their diet. That is, our bodies can't make them on their own. So instead, our diet needs to supply omega-3 fats whole or in certain building blocks like ALA, which we'll introduce soon. There are three types of omega-3 fats well-known for their health benefits: Docosahexaenoic acid (DHA) Eicosapentaenoic acid (EPA) Alpha-linolenic acid (ALA) DHA and EPA are abundant in cold water fish, such as salmon, herring, mackerel, sardines, and anchovies, as well as in marine algae sources. ALA is found in certain seeds and nuts, like flax seed, chia seed, walnuts and pecans. A few details on ALA While DHA and EPA are widely studied for their heart, brain, eye and other health benefits, less is known about ALA and its unique biology and benefits. This doesn't mean ALA is less important. ALA could be especially important for people on vegetarian or vegan diets since ALA is plant-based and can convert into EPA and DHA in the body. Unfortunately, the conversion rate is limited. The conversion from ALA to EPA typically ranges from less than 1% to around 10%, and the conversion from ALA to DHA is smaller, typically ranging from less than 1% to about 5%. Women may have an advantage, though. A landmark study in young women reported an ALA-to-EPA conversion of 21% and an ALA-to-DHA conversion of 9%. The higher conversions for younger women are attributed to the greater need for DHA during pregnancy and breastfeeding. Estrogen may be fueling this "boosted" conversion in women. Below is a simple diagram of ALA's journey to EPA or DHA conversion. As you can see, the ALA-to-DHA conversion is likely smaller than that of ALA-to-EPA due to the longer pathway to DHA. It will require more scientific research to understand if ALA alone supports the body's need for DHA and EPA, depending on a person's health status. Regardless, ALA features in heart and metabolic (diabetes) health, so no matter what our diet, let's ensure we're eating our walnuts. Omega-3 fats benefit the whole body The benefits of omega-3 fats extend from head to toe, and some may surprise you. Reducing cardiovascular risk: Omega-3 fats are associated with reduced resting blood pressure, lower triglyceride fats in the blood and less inflammation. Higher intakes of omega-3 fats may reduce the risk of cardiovascular events. Protecting the brain: Omega-3 fats improve blood flow in the brain, support memory and cognitive abilities and may reduce one's risk for Alzheimer's disease or dementia. Improving mood: Omega-3 fats can help support mental health by reducing symptoms of anxiety and depression. Protecting eye health: DHA is important for supporting eye health and is connected to reduced risk of macular degeneration, a common eye disorder and the leading cause of permanent vision loss. Supporting sleep: Studies indicate that higher consumption of omega-3 fats is associated with a reduced risk of sleep disorders (e.g., insomnia) and may improve sleep length and quality (the efficiency and degree of feeling well-rested). Strengthening bones: Omega-3 fats support bone and joint health by increasing bone density and may reduce the risk of osteoporosis. Nourishing the skin: Omega-3 fats help support the skin by reducing acne, improving skin hydration, aiding in wound healing and reducing the harmful effects of the sun on our skin. How much omega-3 fats are enough? Most Americans need to increase their intake of omega-3 fats. The average US adult consumes about 100–130 mg/day of omega-3s (as a total of ALA+EPA+DHA). Compare this to the following recommendations: ALA: The Institute of Medicine (IOM), which defines US Recommended Daily Allowances (RDAs), recommends 1100 mg (for women) and 1600 mg (for men) of omega-3 per day (as ALA intake, not specific to DHA or EPA amounts). DHA+EPA: The American Heart Association recommends about 500 mg DHA+EPA twice weekly as fatty fish (totaling about 1000 mg/week). International recommendations for healthy adults vary; they range from about 200 mg/day to 1000 mg/day, typically as DHA+EPA. So, if you feel like you're taking in an average or below-average amount of omega-3s, then it's time to ramp up the omega-3s in your diet and nutritional regimen. How do you know you've reached a good level with omega-3 fats? It may be easy enough for you to know by feeling the benefit, of course, but if you're the kind of person who likes to track a hard number, there is a biomarker test called the Omega-3 Index. It measures the amount of DHA and EPA incorporated into your tissue, specifically your red blood cells. You can obtain one at OmegaQuant (no affiliation with this author). Due to their low intake of omega-3s, most Americans have an omega-3 index of 4% or less. However, recent studies show that optimal cardiovascular and brain health is probably at a level of 8%–12%. What you can do to boost your omega-3 fat status: Get enough fatty, cold-water fish (salmon, herring, mackerel, sardines and anchovies) into your diet (also add marine algae sources)—ideally 3-4 servings per week. Go nuts! Have at least a handful of omega-3-rich nuts daily, like walnuts or pecans. Consider a DHA/EPA supplement, though bear in mind that they come in different forms, depending on your need. Fish oil-derived supplements come in the triglyceride or ethyl ester forms of DHA/EPA, which may better target cardiovascular health. On the other hand, phospholipid forms of DHA/EPA may better target brain health (for example, the brain nutrition company I founded uses a type of phospholipid called phosphatidylcholine-DHA/EPA in our product RELEVATE, which is designed for more efficient uptake into the brain, especially as people age). Ultimately, all forms are broadly beneficial; it's a matter of choosing which protective benefit you want to emphasize. If you're vegetarian or vegan, consider an algae-based DHA/EPA supplement. Finally, although taking "mega" doses of DHA and EPA to compensate for a deficiency is tempting, be aware that high dosages, over 5000 mg/day of DHA+EPA, are not recommended. High doses over the long term may interfere with the immune system, increase the risk of bleeding (lowering the ability of platelets to clot) and interact with anti-thrombotic medications like warfarin. Hopefully, this helps you understand omega-3 fats better. Science is still uncovering new information and learning about how to maximize their benefit. It's safe to say, though, that omega-3 fats are indeed healthy, and you should strive to get enough of them. Your body and mind will thank you for it—today and in the future! Resources Resources for this article can be found here. Edward Park, PhD Edward Park is the founder of NeuroReserve, a preventive health and nutrition company focused on healthy brain aging. Ed's background spans over 15 years in the fields of nutritional therapeutics, biopharmaceuticals and medical devices, where he directed R&D, testing and regulatory approval of products to treat people malnourished by cystic fibrosis, pancreatic cancer and preterm birth. Ed's family history of neurodegenerative disease (his father) led him toward brain health, where he realized the powerful role nutrition and dietary patterns can play in reducing the risk of Alzheimer's, Parkinson's and other neurodegenerative conditions. This inspired him to develop a new generation of nutritional products to strengthen long-term brain health and cognition: expert-designed, data analytics-driven and built on the best dietary evidence—leading to the founding of NeuroReserve. Ed holds a PhD in chemical and biomolecular engineering from the Georgia Institute of Technology, where he was a National Defense Science and Engineering Graduate Fellow. He also holds an MS and MBA from the Massachusetts Institute of Technology. As a special offer to SOULFUL Insights readers, NeuroReserve is offering a 15% discount on subscriptions and individual orders. Just use discount code SOULFOODSALON at checkout. Email: epark@neuroreserve.com Learn more about NeuroReserve here: neuroreserve.com Instagram @neuroreserve Facebook @neuroreserve

As we begin to turn the page on another year, I thought it would be fun to share many of the teachings and lessons we have presented about wellness since SOUL Food Salon began eight years ago. There has been so much we have learned, and they follow a few key themes: Maintaining a healthy cardiovascular system translates to better vascular brain health and overall brain health. Reducing chronic inflammation is crucial; we are learning it is the reason for many chronic diseases. Having good metabolic health reduces your risk of obesity, stroke, cardiovascular disease and diabetes. Creating and maintaining a resilient microbiome is crucial to prevent chronic disease. Practicing a healthy lifestyle that includes proper nutrition, restorative sleep, stress reduction, exercise and self-care is of paramount importance to help reduce the risk of chronic disease. When I was a medical student, we had no lessons on lifestyle strategies as a preventive way to combat disease. We’ve now learned how much was missing from our education. Let’s dive deeper into these important lessons so we can be our healthiest selves—it's true preventive medicine! Sleep Sleep more and sleep better. Sleep impacts every aspect of our health, including heart health, brain health, immune function and memory, to name a few. Make sleep a priority whenever possible, and aim to maintain a regular sleep schedule. Quantity and quality matter. For adults: 7–8 hours is ideal; however, the reality is that you need enough sleep so that you're not tired the next day. Optimize your sleep hygiene. Start a wind-down routine every night 30–60 minutes before your bedtime. Dim the lights in the evening. Remove electronics/phones from the bedroom. Electronics emit blue light, which prevents the natural release of melatonin. Keep the room temperature on the cool side (65–70 degrees). Maintain an overall positive attitude toward sleep. Keep your bedroom dark. If needed, try a face mask. If you have insomnia, try focusing on your breath. Limit afternoon naps to no more than 30 minutes. Avoid caffeine six hours before bed. Avoid alcohol within 3–4 hours of bedtime. Alcohol prevents the deeper stages of sleep that are more restorative. One ounce of alcohol can take 5–10 hours to leave the body, resulting in lighter sleep (less restorative). Stress Reduction Reducing stress leads to a decrease in cortisol levels, a decrease in sympathetic nervous system activity and an increase in parasympathetic nervous system activity. Together, they indicate a relaxed state. Nature. Studies have shown that spending time outside is relaxing. Try to spend time in nature every day. Take time to listen to the birds singing, notice the leaves changing colors, view how the sunlight sparkles on the trees and note the natural beauty around you. Sleep. Aim for good quality and quantity sleep. Gratitude: Start a gratitude practice by consciously noticing small things that bring you joy: a clear sky or a flower in bloom. Perhaps, keep a journal of these observations. Social connection/community. There is a strong need for humans to have social connection; our physiology demands human contact. Oxytocin is released through physical touch, and that hormone release has been shown to reduce the stress response. Mindfulness/meditation. Mindfulness is being present and aware with kindness and compassion. It is about being in the here and now. Below are some suggestions on ways to incorporate the practice of mindfulness: Take 10 deep breaths when you are in the car at a red light or stop sign or in line waiting. Pay attention to your breath—both the inhale and the exhale. Try a breathing meditation—Inhale for a count of three or four, pause, exhale for a count of five or six, and pause. The count does not matter as long as the out-breath is significantly longer than the in-breath. The longer exhale activates the parasympathetic nervous system, which leads to relaxation. Nutrition Most of the leading causes of death in the US are preventable and related to what we eat. Proper nutrition is essential for overall health and to reduce the risk of chronic diseases such as cancer, obesity, diabetes, cardiovascular disease and dementia. A diet that prioritizes health should be nutritionally adequate, meeting our macro- and micro-nutrient needs and reducing the risk of diet-associated disease. Cooking at home is the surest way to eat more of the good stuff and less of the bad stuff. You know exactly what you are putting into your food. Increase the following in your food: Fiber. Fiber is found in all plant foods and provides numerous health benefits, including aiding in blood sugar stabilization, healthy digestion and weight control, and lowering cholesterol. In addition, eating high-fiber foods helps ensure we are feeding our microbial partners, known as the microbiome. We are learning more every day about its key role in regulating and maintaining our overall health. The FDA recommends consuming at least 30–38 grams of dietary fiber daily. Plants. Aim for most of your plate to be full of a variety of different colored fresh plants. Fermented foods. Studies have found a correlation between consuming fermented foods containing live microorganisms and better health outcomes. Add fermented foods (kimchi, active culture yogurt, sauerkraut, kombucha, miso soup, tempeh, fermented vegetables) to your diet daily. Look for live and active cultures listed on the ingredients label. Shop in the refrigerator aisle: fermented foods that are shelf-stable (in unrefrigerated jars or cans) likely do not have active cultures. Whole foods. Eat foods in their most natural form. Water. Water should be your drink of choice. Flavor it with citrus fruit and/or cucumber if you like. Decrease the following in your food: Sugar and sugar-sweetened drinks. A diet high in sugar and sugar-sweetened beverages can lead to insulin resistance, inflammation, type 2 diabetes, atherosclerosis and cancer. Processed food. Pay attention to the ingredient list and the nutrition facts label on processed food items. Saturated fat. Fat that is solid at room temperature is saturated. High saturated fat can lead to elevated LDL cholesterol (the bad cholesterol). Saturated fat is found in cheese, red meat, convenience foods (e.g., take-out, fast food or frozen foods), pizza, desserts (especially ice cream), bacon, salami and other processed meats. Avoid processed meats (classified as carcinogenic) and limit red meat (probably carcinogenic) to 1–2 x/week. Move meat from its starring role at the center of the plate to a smaller portion on the side. Alcohol. The current 2020–2025 dietary guidelines for Americans recommend limiting your alcohol intake to fewer than two drinks a day for men or one drink a day for women. Exercise I Movement Regular exercise imparts tremendous health benefits, including better vascular health (which leads to a lowering of blood pressure), reduced risk of cardiovascular disease, improved lung function, strengthened bones and muscles, lowered risk of some cancers, reduced risk of type 2 diabetes and improvement in metabolism. Adults should aim for at least 2.5 hours of moderate-intensity activity or 75 minutes of vigorous physical activity each week. They should also engage in muscle-strengthening activities at least two days a week. Older adults should incorporate balance training. As with virtually everything, moderation is key. Movement is critical, but too much exercise can be harmful. Self-care Focusing on your mental, physical and emotional health is a priority, and you shouldn’t feel guilty about it. Treat yourself with care. Allow yourself time to unplug, recharge and refuel. Be intentional about tuning in to what you need to nourish yourself. I am passionate about living the healthiest version of myself, and I love that you are sharing this journey with me. If you’re just beginning on this path to better health, create an environment of success. Start with some small and simple changes, realizing these small adaptations can grow into significant changes that will result in better long-term health. Remember to take time for yourself because self-care is essential to overall wellness. And, remember, enjoy the journey! Resources: Healthy Habits: The Experts Guide for a Healthy Lifestyle: porch.com/advice/healthy-habits-the-experts-guide-for-a-healthy-lifestyle Jeanne Rosner, MD Jeanne Rosner is a board-certified anesthesiologist who practiced pediatric anesthesia at Stanford Medical Center for nearly 20 years. In 2011, she began teaching nutrition classes in her son's 5th-grade science class. It was an "aha" moment for her. She realized that learning and teaching about nutrition, health and wellness in her community was her destiny. Since retiring from anesthesia, she has been a nutrition educator at local middle and high schools throughout the Bay Area. She teaches students about the importance of eating food closest to the source, making good food choices and eating in a balanced and moderate way. Jeanne started SOUL (seasonal, organic, unprocessed, local) Food Salon in 2014. SOUL Food Salon's mission is to educate and empower people to be healthier. She holds events (salons) at which experts in the health and wellness community share their knowledge on how to lead a healthier life. www.soulfoodsalon.com jeanne@soulfoodsalon.com Instagram: @soulfoodsalon

Dr. Khalsa has had a lifelong interest in mindful living as the basis for long-term vitality of mind, body and spirit. She completed a residency in Internal Medicine at the Mayo Clinic in 2005 and is board-certified in Internal Medicine, Integrative Medicine, Lifestyle Medicine and Hospice/Palliative Medicine. She has deepened her studies in health and healing by becoming a yoga instructor and Reiki master and participating in a two-year full-time program on Ayurveda at The Ayurvedic Institute in Albuquerque and India. Through her work as an integrative medicine PCP, University of Arizona Integrative Medicine fellowship instructor and consultant to other medical practices, she has dedicated her career to promoting a better clinical understanding of the link between long-term vitality and our daily choices. Dr. Khalsa is currently focusing her energy on supporting physicians who want to expand their understanding of new healing methods through an experiential process that draws on Ayurveda, yoga, mindfulness and plant-based nutrition. Dr. Khalsa loves to spend time immersed in nature, exploring forests and gardens in her free time. And if the conditions are right, she enjoys photographing nature and all of its biodiversity. She recently moved from Phoenix to the California coast, where she's been actively exploring gardens, forests and towns—a welcome reprieve from the arid desert. At the Salon: This was an immersive salon that introduced the principles of Ayurveda that can sustain your health and vitality through the holiday season. Dr. Khalsa shared a sampling of food that is Ayurvedically inspired to bring balance in the new year. ​Contact Information: Facebook: @Luminousfoods Instagram: @doctorsirichand Pinterest: @DoctorSiriChand Website: DrSiriChand.com Click here to see the salon presentation. Click here for the salon recipes.

Dr. Caroline Okorie is board certified in Sleep Medicine, Pediatric Pulmonary Medicine and Pediatrics. She is a Clinical Associate Professor at Stanford Children’s Health. She obtained her Medical Degree and Master’s in Public Health at the University of Arizona before going on to a residency and chief residency in pediatrics at Oregon Health & Science University. She completed both her Pediatric Pulmonary Medicine and Sleep Medicine fellowships at Stanford Medicine. Her clinical interests include management of insomnia, parasomnias as well as sleep disordered breathing. She is also building expertise in integrative medicine and plans to use this to encourage patients and families to consider integrative and holistic approaches to improve sleep health and quality of life. Outside of work, she enjoys reading and is hoping to get back into writing. She loves everything tennis and strolling through nature. She adores any type of good music and is always open to recommendations. Contact Information: email: cokorie@gmail.com Twitter: @OkorieMD At the salon: Dr. Okorie briefly reviewed some principles of sleep, including why we sleep and consequences of poor sleep. She addressed insomnia and contributing factors to it. She reviewed some ideas about how to prevent and treat insomnia. She also included a discussion about some integrative medicine practices that support healthy sleep. Click here to see the powerpoint presentation. Click here to watch the salon video.

Are you an athlete (I believe there is one in all of us!), a recreational exerciser or a dancer? Or do you feel you have become stiffer as the years have gone by? Stretching regularly and appropriately is an invaluable tool for maintaining your body's range of motion and is a necessary component of long-term health. However, knowing how and when to stretch can be confusing. Let's take a deep dive into the world of joint and soft tissue end range of motion to help you establish a daily health routine. There are essentially two types of stretching: dynamic mobility and static stretching. Dynamic mobility involves controlled movement. Static stretching, on the other hand, consists of an absence of movement once in the desired position of the stretch. The data supporting the effectiveness of stretching are somewhat limited, but they indicate that dynamic mobility is better at warming up the body and preparing it for exercise and static stretching is more effective at increasing limb range of motion (ROM). What is dynamic mobility? Dynamic mobility helps improve joint range of motion but typically does not involve movement at the end ranges of motion. If you have ever watched a sports team warm up before a game, you have most likely seen the group engage in a series of dynamic mobility exercises. Dynamic mobility involves movement and momentum to help increase joint range of motion; it warms up the body for forthcoming exercise, helps to hydrate the fascia by pushing fluid through the tissues and stimulates the nervous system. There are many types of dynamic mobility, including traditional exercises like jumping jacks, arm circles and walking lunges. Stringing several yoga poses together as a flow is another dynamic mobility exercise. The following are some examples of dynamic mobility exercises (see video link for visual examples): "World's Greatest Stretch" (my personal favorite) Walking lunges with overhead reach Cossack stretch Walking toe touches Wide stance windmills Crab reach Ballistic stretching (a type of dynamic stretching) relies heavily on momentum and includes bouncing or swinging at the end range of motion. It can benefit certain populations like athletes, but it comes with more risk. Anytime you "force" tissue to extend beyond its ROM, you risk damaging the soft tissue. I have pulled my hamstring more than once (embarrassing, but it happens!) doing ballistic toe touches after finishing a long run. On the flip side, ballistic open arm chest stretches can feel great as a mobility break for those who work at a computer for long periods of time. Here are some examples of ballistic stretching (see video link): Leg swings Standing toe touch Sitting toe touch Open arm chest stretch Arm circles Seated butterfly stretch What is static stretching? Static stretching involves holding a stretch at an end range of motion for a proscribed amount of time (optimal time being 30 seconds) while minimizing the amount of momentum used. On his popular podcast, Stanford neuroscientist Dr. Andrew Huberman reviewed the current science behind limb range of motion and flexibility and how to use science-supported protocols to increase them. He suggests holding each stretch for 30 seconds, targeting each limb or muscle group for a total of five minutes per week. Being consistent with your static stretching routine is key to slowly increasing your range of motion and helping prevent injury. Static stretching can be either passive or active. Passive static stretching involves using a partner or props to help increase your range of motion by slowly expanding the end range. Below are some examples of passive static stretching (see video link): Supine hamstring stretch with strap Assisted neck stretch Frog stretch Hurdle stretch or the splits Chest stretch using a doorway Elevated adductor stretch In active static stretching, one holds the stretch at the desired ROM by contracting the opposing muscles (antagonist) while relaxing and stretching the desired muscles. Given that many of us have tight hip flexors from sitting too much, a great active stretch would be a kneeling hip flexor stretch (see how in the video below). Active static stretching aims to progressively and incrementally increase your ROM to maximize the benefits of the stretch. The key here is to hold each stretch for 30 seconds. Here are some examples of active static stretching (see video link): Kneeling hip flexor stretch Supine hamstring stretch Seated butterfly stretch Neck stretch Overhead triceps stretch Open arms chest stretch Stretching every day As a trainer, the first question I ask my clients is, what are your goals? If your priority is to increase limb ROM, then static stretching would be your best option. On the other hand, if your goal is to warm up the body to prepare and activate the muscles you will target during a workout or athletic performance, I would steer you toward dynamic mobility. As mentioned earlier, the data are limited, but most research supports dynamic mobility for warm-up and prep and static stretching after exercise to increase ROM. For a dynamic mobility warm-up, you will want to focus on warming up the ankles, hips and thoracic spine (the big three) for about 5–10 minutes. String together a series of two to four exercises for six to eight repetitions each. For example, start with the "World's Greatest Stretch" for eight reps, follow with eight reps of front lunges with opposite arm overhead reach, and finish with windmills for eight reps. You can do one set or repeat the sequence if needed. Another great option for general fitness (and for recovery days for athletes) is to pair a dynamic mobility set with a post-workout static stretching session. For example, do the above mobility set for four rounds before your workout and follow it with two to four minutes of static stretching. Pick two stretches and complete two sets of 30-second holds each (see above for a list of static stretches). There is no "one size fits all" stretching regimen, as every person needs different types of movement for their body. Practicing stretching habits that complement your fitness and health routine and are aligned with your health goals is essential. Refer to this guide and the stretching examples I provided to determine what is best for you. Resources Huberman, Andrew. Improve Flexibility with Research-Supported Stretching Protocols. Huberman Lab. hubermanlab.com/improve-flexibility-with-research-supported-stretching-protocols/ Ramsay, Craig. (2012). Anatomy of Stretching A Guide to Increasing Your Flexibility. Thunder Bay Press. amazon.com/Anatomy-Stretching-Anatomies-Craig-Ramsay-ebook/dp/B0095XKMW4 Chowdhary, Sunita. (2020). Top 7 Benefits of Ballistic Stretching. medindia.net/patients/lifestyleandwellness/top-7-benefits-of-ballistic-stretching.htm Preiato, Daniel. (2021). Active Stretching Is the Static Stretching You Haven't Tried Yet. healthline.com/nutrition/active-stretching Cronkleton, Emily. (2020). Passive Stretching: What It Is and How to Do It. healthline.com/health/exercise-fitness/passive-stretching NIH: National Institute on Aging. (2020). Maintaining mobility and preventing disability are key to living independently as we age. nia.nih.gov/news/maintaining-mobility-and-preventing-disability-are-key-living-independently-we-age Stella Bergan, MEd, NASM CPT Stella is an NASM Certified Personal Trainer and Institute of Motion Applied Health and Human Performance Specialist. She obtained her undergraduate degree from Birmingham-Southern College and graduate degree from the University of Virginia. Her training as a therapist, along with a background in executive coaching/organizational strategy, provide the foundation for helping her clients make the changes they need to live healthier, more productive lives and perform at their optimal level. Stella takes an integrative approach to wellness and performance and believes that making small, sustainable changes over time can lead to profound improvements in overall health and performance. She works with some of Silicon Valley's top executives. She is a mom, an avid trail runner, loves to travel and really enjoys converting teenagers into green smoothie drinkers. StellaFit, 650.245.8603 www.stellafit.com stellabergan@comcast.net Instagram: @stellabergan

Most health and sustainability experts agree that most people would benefit from a plant-forward diet. Fruits, vegetables, legumes, whole grains, nuts and seeds contain a wide variety of beneficial nutrients for us and our gut microbiota. Plants produce molecules called polyphenols, which often serve as defenses for plants and have antioxidant and other favorable properties for the humans who consume them. And yet, proponents of fad diets like the Paleo and ketogenic diets have blamed the components of plants known as antinutrients for many of the inflammatory diseases that people experience. Should we be concerned about antinutrients in our diets? What are antinutrients? Antinutrients are compounds found in plant foods that inhibit the body's ability to absorb certain nutrients after digestion. The mechanisms typically fall into two categories: binders of micronutrients or inhibitors of digestive enzymes. Plants produce antinutrients to protect themselves from predators, which wisely learn to avoid consuming plants high in these compounds after suffering from their effects. When humans eat macromolecules (carbohydrates, fats and proteins) that contain these antinutrients, these foods can often pass through the gastrointestinal tract undigested. Unfortunately, fundamental nutritional deficiencies and/or inflammation can result. Antinutrients are particularly abundant in grains and legumes, often considered staples in healthy diets; these foods are also excellent sources of fiber for our microbiota. See the table below for a list of common antinutrients. As examples: Antinutrients called phytates have a high affinity for the minerals listed in the table above, which may cause them to bind, thus preventing the absorption of those minerals in the GI tract. Unfortunately, the human body doesn’t make the enzyme (phytase) that breaks down phytates, meaning we can't easily inhibit their action. Oxalates chelate (or bind to) calcium and prevent it from being absorbed. In sensitive individuals, high-oxalate diets can cause calcium crystals to form that may stick together and result in a solid mass (a kidney stone). Lectins have also received increased negative attention. They are proteins found primarily in legumes and nightshade vegetables (i.e., members of the Solanaceae family such as tomatoes and eggplant) used for cell signaling or as protective mechanisms; they can also be found in animal foods, though these lectins are typically not problematic. In our bodies, lectins bind to cells lining the small intestine and cause atrophy and malabsorption. The good news is that many food processing methods deactivate lectins. Therefore, only the consumption of raw legumes and grains (which is uncommon) would be a cause for concern. Not all antinutrients are problematic, and they may also have positive effects. For example, tannins are polyphenols, which act as antioxidants in humans and contribute to the health properties of teas, wine and more. Similarly, other antinutrients may be metabolized by our gut bacteria to produce beneficial compounds. How does consuming antinutrients impact my health? Although their effects on digestion and absorption are acknowledged, we don't yet have clinical evidence to show that eliminating these molecules from the diet can cure diseases like autoimmune diseases. Indeed, the Mayo Clinic doesn't recommend avoiding antinutrients in the diet but instead advises monitoring symptoms and experimenting with elimination diets when necessary. In addition, preparing these foods appropriately (see below) can potentially mitigate the adverse effects of these foods on the immune system and gastrointestinal tract. Therefore, broad recommendations to avoid foods that contain them are typically unfounded. How do humans reduce antinutrient content in foods? To prevent the negative effects of antinutrients, cooks around the world have discovered over time that soaking, sprouting, fermenting and wet heating food all help to inactivate the antinutrients in plant foods: Soaking plant foods for an extended period and then disposing of the soaking water reduces antinutrients because many antinutrients are water-soluble. Sprouting helps to degrade antinutrients such as phytates and protease inhibitors. Fermenting involves the use of bacteria to oxidize carbohydrates, creating an acidic environment that can deactivate antinutrients. Heating foods through various methods can degrade antinutrients. Further, foods can undergo multiple forms of processing, which can have a cumulative effect on antinutrient composition (as evidenced in the chart below). Studies suggest these methods work to varying degrees, and they differ by food group. For example, soaking and cooking have been shown to reduce levels of lectin and oxalate but not necessarily of phytic acid. Also, soaking and then cooking better reduces antinutrient levels than either method alone. The figure above shows the cumulative effects of various types of processing on the phytic acid content in soy. These processes can also improve nutritional quality. Sprouting, for example, breaks down some of the starch, helping to lower the glucose response after consumption. Also, fermented foods (that are not pasteurized) contain live probiotics that help feed our gut microbiota. A recent study suggested that among legumes, soybeans contain the most antinutrients. Traditionally, soy was properly processed to remove these antinutrients before consumption. However, the isolated forms of soy protein found in many industrially processed foods in the standard American diet have not been processed using traditional methods (see figure below for examples). And because shelf-stable convenience foods have become increasingly prevalent in our food supply, the standard American diet doesn't contain many other plant foods that have been prepared in ways that inhibit or remove antinutrients. Thankfully, more people are buying foods that have been properly processed (i.e., with antinutrients removed) and learning how to do it themselves. They are driven by their concern about the connection between diet and inflammation, irritable bowel syndrome (IBS) and even the links between gut health and distant organ systems. This is helping to grow the market for more nourishing foods processed using traditional methods. Milling grains can also reduce their phytonutrient content, but this process of refining also removes many of their beneficial nutrients. Biotechnology is also using methods to change plant genetics to reduce the creation of these molecules in agricultural production or to fortify the micronutrients to maximize bioavailability. This is particularly appropriate in developing countries where people suffer more from micronutrient deficiencies. How should I manage antinutrients in my diet? Foods should not necessarily be avoided just because of their antinutrient content. They may have many other beneficial properties, such as omega-3 fatty acids, protein or fiber. Also, everybody's body responds differently, so antinutrients may not be a concern for many individuals. Soaking, sprouting, fermenting and some methods of heating food help to inactivate the antinutrients in plant foods. Choose these forms (especially for soy) at the grocery store, when possible, and try these methods when cooking foods that contain antinutrients at home. Talk to your doctor or a registered dietitian if you notice symptoms like diarrhea, flatulence, fatigue, etc., that you think may be attributed to your diet. They may work with you on an elimination diet to determine the culprit food group and how to remove it without risking deficiencies. These molecules may be particularly problematic if you have an inflammatory disease, such as Crohn’s disease, colon cancer or rheumatoid arthritis. You should seek assistance from a dietitian in identifying sources of antinutrients in your diet and the best ways to remove them. Resources A full list of resources can be found here. Christina Badaracco, MPH, RD Christina is a registered dietitian and author who aims to improve access to healthy and sustainable food and educate Americans about the connections between food and health. She loves to experiment with healthy recipes in the kitchen and share her creations to inspire others to cook. Christina completed her dietetic internship at Massachusetts General Hospital and earned her Master of Public Health degree from the University of California, Berkeley. Previously, she graduated with a degree in Ecology and Evolutionary Biology from Princeton University, after conducting her thesis on sustainable agriculture and energy in Kenya. She has done clinical nutrition research at the National Institutes of Health, menu planning and nutrition education at the Oakland Unified School District and communications at the Environmental Protection Agency's Office of Water. She has also enjoyed contributing to children’s gardens, farmers markets and a number of organic farms. cbadarac@gmail.com www.linkedin.com/in/christina-badaracco/

Liv Wu is a chef, award-winning cookbook author (The Grand Wok Cookbook) and an 18-year food journalist for the San Francisco Chronicle's Food and Wine section. She was the founding chef-instructor and program manager of the Teaching Kitchens at Google where she guided the chef instructors at the company's Mountain View, Pittsburgh, Seattle, New York and London campuses. She retired from Google in 2016 after 9 1/2 years in the food program. ​ In 2017, she founded Liv Cook Eat, a cooking school and learning kitchen. Liv has trained instructors at various university culinary/ nutrition programs—in Baltimore, Chicago and Portland—and locally. She hosts team builds and other one-time, seasonal events (they get five-star ratings on Airbnb experiences!). She's led thousands of cooks and would-be cooks through the process of cooking recipe-free. Her philosophy is that awareness of flavors creates a joy of eating and the freedom to create flavors brings joy and health to cooking. She offers a virtual, hybrid version of her signature course, Food & Flavor Fundamentals, which is offered in short three-class modules. Her test class this summer received rave reviews. At the Salon: Liv spoke about her passion project—guiding people to cook intuitively and recipe-free. Her method helps both beginners and seasoned cooks build confidence. It saves time, uses seasonal and healthy ingredients and develops creativity while building community. She guided participants through her process and philosophy, which leads her students to better cooking with the freedom to experiment with flavors. Contact Information livcookeat.com livcookeat@gmail.com Click here to view Liv's powerpoint presentation.

During my dietetic internship at Massachusetts General Hospital, I was inspired by the wonderful model of nutrition and culinary education provided to clinicians and patients alike at the nearby Boston Medical Center (BMC). As the largest safety-net hospital in New England, it is also the primary teaching hospital for Boston University's School of Medicine. With a teaching kitchen offering free classes by a registered dietitian and other team members, a rooftop garden providing greens and other foods to its cafeteria and a "preventive food pantry" distributing healthy food to patients in need, BMC seeks to address the barriers to good health posed by poor nutrition. It also offers extensive programming to educate medical students about nutrition, behavior change and opportunities to address food insecurity in the local community. By doing so, it serves as inspiration to other providers around the country. The need to elevate nutrition in healthcare Food insecurity, obesity and lifestyle-related diseases are big contributors to the $4.1 trillion in annual healthcare-related costs in the US. Compared to most other high-income countries, the US has the highest adult obesity and infant mortality rates and the lowest life expectancy. Here are a few statistics that indicate the need for improved nutrition in healthcare: Heart disease and stroke account for almost one-third of deaths in America and cost $216 billion per year in healthcare costs. More than one-third of Americans have prediabetes (caused by insulin resistance and a precursor to type 2 diabetes) and various forms of heart disease. Nearly ninety percent of American adults fail to consume the daily amounts of fruits and vegetables recommended by the Dietary Guidelines for Americans. Since the 1960s, Americans have decreased both the amount of food they prepare at home and the time they spend preparing it. However, foods prepared at home tend to be more nutritious than foods prepared away from home. Many health professionals have been calling for expanded incorporation of nutrition curricula into medical education and training to address these problems. While registered dietitians (RDs) ultimately hold this expertise, doctors and other allied health professionals should have at least a basic understanding to be able to answer their patients' questions, address their nutritional needs and know when to refer them to RDs for counseling or more acute interventions in an inpatient setting. The most recent nationwide survey indicates that only 29% of American medical students receive the National Academy of Sciences' recommended minimum of 25 hours of nutrition education and only 29% of schools require what they consider to be a full nutrition course (which typically translates to at least five hours during the entire program). According to a series of surveys by Adams et al. in 2015, the number of medical schools with a required nutrition course has declined since 2000, and the percentage of schools meeting the 25-hour recommendation fell by two percent. Over this time, rates of diabetes, heart and kidney transplants and many other conditions often attributed to poor diet have continued to rise. And yet, a 2008 survey showed that more than 80% of physicians believed they lacked enough training in nutrition to be able to offer helpful information to patients. In a 2017 survey of cardiologists—who so often treat and manage lifestyle-related diseases—90% reported receiving no or minimal nutrition education during fellowship training. Lacking both knowledge of the field and the skills required to educate and counsel patients, these providers are inadequately prepared to effectively address the nutrition issues that contribute significantly to the current burden of poor health in the US. A 2019 systematic review amalgamated these individual findings, leading the authors to call for institutional commitments to make nutrition education compulsory, establishing nutrition competencies and funding innovative curriculum initiatives. Medical schools making progress Indeed, some medical schools are starting to catch on. In 2018, UCLA launched a new pediatric public health elective course (led by a dietitian and public health professional) to teach physicians about pediatric nutrition and basic cooking skills. They also work on counseling skills to better work with patients to improve their dietary behaviors. Stanford Medical Center physicians (who are also chefs) teach basic cooking and nutrition elective classes to medical and physician assistant students. The Teaching Kitchen @ Stanford National networks are working together to enhance basic cooking skills and nutrition education to improve health. The Teaching Kitchen Collaborative, co-led by the Harvard TH Chan School of Public Health and the Culinary Institute of America, was formed in 2016 to share resources and best practices to propel this movement forward. The group compiles research to build an evidence base showing that basic culinary education can improve health in various settings and has begun an NIH-funded, multi-site trial. The goal of these efforts is to expand similar opportunities around the country by removing barriers to implementation. The Bipartisan Policy Center, the American College of Sports Medicine and the Alliance for a Healthier Generation also launched a joint effort in 2016 that helped lay the groundwork for teaching health professionals how to work effectively with patients to prevent or treat obesity. Their efforts resulted in "Provider Competencies for the Prevention and Management of Obesity" to help standardize curricula, an "Innovation Award for Health Care Provider Training and Education" and advocacy to improve reimbursement for health services that target lifestyle factors (as opposed to the more traditional fee-for-service payments that encourage additional treatments). Other experts (Adams et al.) suggest additional tactics, such as a greater emphasis on nutrition in clinical rotations to avoid overburdening classroom curricula and teaching nutrition interventions alongside the options for medicine or surgery (when appropriate) to prevent the need for the latter. While it will always be important to refer patients to RDs for the most comprehensive nutrition interventions, doctors have tremendous potential to improve health and reduce expensive medical treatments with a greater emphasis on what is known as lifestyle medicine. Recent actions from the federal government also offer promise. The White House Conference on Hunger, Nutrition and Health coincided with the release of the administration's national strategy on nutrition and health. Its second pillar, "Integrate Nutrition and Health," includes the tactic to "strengthen and diversify the nutrition workforce," which aims to increase the workforce of RDs and enhance nutrition education for medical professionals through graduate medical education curriculums, board exams and postgraduate training. Earlier in 2022, the House of Representatives passed a resolution to call on these same entities to provide "meaningful physician and health professional education on nutrition and diet." What should patients do with this information? To answer nutrition-related questions and provide counseling, always consult with an RD. Check your insurance plan's coverage before making an appointment. Ask your primary care or specialty physician for a referral if they don't automatically suggest it. Educate yourself using sources written by public health and nutrition experts, such as the Academy of Nutrition and Dietetics, The Nutrition Source from the Harvard TH Chan School of Public Health and Berkeley Wellness Newsletter from the UC Berkeley School of Public Health. Remember that a healthy and adequate diet, physical activity and quality sleep are some of the most important steps you can take to maintain good health, prevent disease and even optimize outcomes during most types of medical treatment. Resources To view the full list of resources, visit here. Christina Badaracco, MPH, RD Christina is a registered dietitian and author who aims to improve access to healthy and sustainable food and educate Americans about the connections between food and health. She loves to experiment with healthy recipes in the kitchen and share her creations to inspire others to cook. Christina completed her dietetic internship at Massachusetts General Hospital and earned her Master of Public Health degree from the University of California, Berkeley. Previously, she graduated with a degree in Ecology and Evolutionary Biology from Princeton University, after conducting her thesis on sustainable agriculture and energy in Kenya. She has done clinical nutrition research at the National Institutes of Health, menu planning and nutrition education at the Oakland Unified School District and communications at the Environmental Protection Agency's Office of Water. She has also enjoyed contributing to children’s gardens, farmers markets and a number of organic farms. cbadarac@gmail.com www.linkedin.com/in/christina-badaracco/

Few foods in the modern diet have such a shadow of confusion surrounding them as the egg. Though a rich and versatile source of protein and micronutrients, many people continue to be concerned about their saturated fat and cholesterol content. Navigating the latest nutrition research is indeed complicated. Many consumers are also concerned about the sustainability and animal welfare of egg production, struggling to understand the difference between labels like "antibiotic-free," "cage-free" and "pasture-raised." Can eating eggs be good for people and good for the planet? How are egg consumption patterns changing? Despite changing recommendations regarding the consumption of cholesterol—and eggs, in particular—eggs have remained dietary staples. Consumption fell slightly around the middle of the 20th century but is now somewhat stable, around 250 eggs per person per year. Average per capita egg consumption in the US, based on USDA Economic Research Service loss-adjusted food availability data. https://www.ers.usda.gov/data-products/food-availability-per-capita-data-system/; https://www.ers.usda.gov/publications/pub-details/?pubid=104507 Although chicken eggs are the most common, we also occasionally eat eggs from ducks, geese, quail and even fish (called roe). Varieties like duck eggs may be slightly higher in protein, omega-3 fatty acids and some vitamins, but overall, nutrient content does not vary widely among the different eggs. (Note that fish eggs are much smaller than bird eggs; a 1.5-tablespoon serving contains amounts of most nutrients comparable to those in bird eggs.) What are the nutritional benefits of eating eggs? Eggs are beloved as a quick and affordable source of protein. They can be purchased at most stores for low costs and at high-end farmers markets. It's typically possible to buy two organic eggs for less than $0.75, which is half the price of a serving of organic chicken that would provide the same amount of protein. A large batch of boiled eggs can last many days to feed one person, while a large pan of scrambled eggs can easily feed a crowd. Egg yolks are the most calorie-dense portion of eggs, but they also contain the richest source of micronutrients. Except for patients with genetic lipid disorders, the yolk should typically be consumed along with the white to maximize the nutritional benefits of eggs and minimize waste. In addition to protein (primarily found in egg whites), eggs are a source of many other essential compounds. Egg yolks are one of our richest dietary sources of vitamin D. Vitamin D plays several important roles in our bodies and it's challenging to obtain sufficient quantities through our diet. Two eggs provide 20% of our Recommended Dietary Allowance. So, when combined with a serving of full-fat dairy, fortified cereal and plenty of sunshine (protected with sunscreen, of course), eggs can provide a significant contribution toward a recommended daily dose of vitamin D in the diet. Egg yolks are also excellent sources of zeaxanthin and lutein, two carotenoids known for their role in promoting eye health by blocking blue light and reducing the risk of advanced age-related macular degeneration. Finally, eggs are known for providing a rich source of choline. This essential nutrient is involved in many metabolic and neurologic processes (including supporting memory) and is indeed an important part of the diet. You might recall reading this Insight about TMAO, suggesting that choline is one of several nutrients that increase the production of this atherogenic compound. Choline has also been shown to increase homocysteine in the blood; at high concentrations, this promotes inflammation and dyslipidemia (or elevated blood lipids). However, prospective studies have typically failed to find a significant relationship between choline intake and cardiovascular disease outcomes. Most experts believe that moderate consumption is indeed safe—and even beneficial. Nutrients found in egg white and yolk. Data source: https://fdc.nal.usda.gov/ How have recommendations about egg consumption changed? Until the last decade, health professionals and nutrition researchers typically recommended limiting egg consumption to avoid excess cholesterol. Since each large egg contains more than 180 mg of cholesterol, two eggs provide more than the daily limit of 300 mg previously recommended in the Dietary Guidelines for Americans. However, as we have learned that dietary cholesterol is not closely linked with serum cholesterol (except for in people with genetic lipid disorders and possibly those with diabetes), most researchers now believe eggs should no longer be limited solely due to their cholesterol content. Indeed, according to 2013 and 2020 meta-analyses, moderate egg consumption is not associated with an increased risk of heart disease. It has been suggested that some of the fats called phospholipids found in eggs have a somewhat protective effect against elevating blood cholesterol. A 2019 prospective cohort study in JAMA found the opposite: among U.S. adults, higher consumption of cholesterol or eggs was associated with an increased risk of heart disease and death. The relationship followed a dose-response pattern, meaning higher consumption was associated with a greater risk. A 2022 systematic review and updated meta-analysis also showed that greater dietary cholesterol and egg consumption were associated with increased risk of overall heart disease-related mortality. However, the increased risk was measured based on increments of 1 egg or 300 mg per day, which exceeds the average daily intake of eggs and total cholesterol. Therefore, the findings may not apply to Americans consuming less than this amount. Given the heterogeneity in these findings, recommendations about eating eggs in low to moderate amounts are therefore not likely to change in the near future, but it is important to be aware—as in all areas of nutrition research—that we very rarely know when we reach a sound conclusion. Indeed, a subsequent umbrella review of meta-analyses looking at egg consumption and human health in August 2019 found no association with adverse health outcomes. What are the healthiest ways to eat eggs? Cooking eggs has been shown to increase their protein availability. It also kills bacteria and makes them safe to eat. Since they contain plenty of fat already, they need only be cooked in enough oil to prevent sticking if fried or scrambled. As with many other foods, cooking destroys some micronutrients and other beneficial compounds, such as carotenoids. Overall, boiling seems to lead to less degradation than higher-heat methods like frying and scrambling. Since eggs cooked in water can only reach 212 degrees F, boiling and poaching may be the healthiest ways to eat them. Baked eggs have been shown to contain less vitamin D, which we already have a hard time getting in our diets. Finally, higher-heat cooking causes the cholesterol in eggs to oxidize, meaning they are more atherogenic and stronger contributors to heart disease. Keep in mind that ingredients added to eggs can also support the health benefits of your meal; cooking with extra virgin olive oil and/or adding spices will introduce various beneficial compounds, for example. What are some alternatives to eggs? People may want to find alternatives to eggs to reduce their environmental impact, ensure animal ethical treatment or for other reasons. Other plant-based sources of protein, such as nuts, seeds, legumes and fermented soy products, can be good substitutes (although they don't provide the same micronutrients). Because of their fiber content, ground flax and chia can serve as good binders for those interested in replacing eggs in baked goods. They also contain healthy omega-3 fatty acids and some protein. Aquafaba, which is the liquid in chickpea cans, can be whipped to serve as a leavening agent in baked goods and meringue. This article on egg substitutes offers various alternatives that can be incorporated into different recipes. Following the increasing availability of plant-based meat and dairy products on the market, various brands selling plant-based eggs in different forms have come to market in recent years. The most common versions are made of mung bean isolates and processed oil or soymilk powder and cellulose, though some newer versions have more wholesome ingredients like organic tofu or nuts. Note that most of these products are lower in almost all micronutrients than real eggs; some are also lower in protein. What are the best ways to incorporate eggs into my diet? Choose eggs from pasture-raised hens, if available. These hens can roam outside and have a more nutritious diet, meaning their eggs are also more abundant in nutrients (such as vitamins A and E, omega-3 fatty acids and more). Choosing organic eggs helps to ensure the feed was free of GMOs and antibiotics. The "hormone-free" label on eggs doesn't mean anything, since chickens are never fed hormones to promote growth. If possible, buy your eggs from a farmers market to ensure the farmer earns a decent profit and can vouch for his/her production practices. Two eggs provide 14 grams of protein, which is ample for a meal when incorporated with other components. Restaurants often serve omelets with much more egg than this, so they can be shared or provide plenty for leftovers. The latest evidence suggests it is probably fine to eat eggs a few times a week, but most people should probably not eat them in large quantities or every day. If you choose to avoid eggs (or animal products in general), plant-based sources can provide ample protein and fat. Just ensure you are getting enough vitamin A, vitamin D and other micronutrients from other sources and read the ingredient list to avoid those you don't recognize. Resources The full list of resources can be found here. Christina Badaracco, MPH, RD Christina is a registered dietitian and author who aims to improve access to healthy and sustainable food and educate Americans about the connections between food and health. She loves to experiment with healthy recipes in the kitchen and share her creations to inspire others to cook. Christina completed her dietetic internship at Massachusetts General Hospital and earned her Master of Public Health degree from the University of California, Berkeley. Previously, she graduated with a degree in Ecology and Evolutionary Biology from Princeton University, after conducting her thesis on sustainable agriculture and energy in Kenya. She has done clinical nutrition research at the National Institutes of Health, menu planning and nutrition education at the Oakland Unified School District and communications at the Environmental Protection Agency's Office of Water. She has also enjoyed contributing to children’s gardens, farmers markets and a number of organic farms. cbadarac@gmail.com www.linkedin.com/in/christina-badaracco/