WHAT TO TELL YOUR PATIENTS

We are what we eat -- and that ain't good

Sitting down to dinner isn't simple any more

By Robb Beattie

With the furor over trans-fats and childhood obesity, a new report indicates that Ontarians, like other Canadians, are not eating the five servings of fruit and vegetables a day that can contribute to lowering bowel and lung cancer risk, not to mention angina, MI, peripheral vascular disease and stroke.

The Ontario Nutrition and Cancer Prevention Survey asked 3,000 Ontario adults about their fruit and vegetable intake, their weight and height and their physical activity. The depressing finding was that only 55% of men and 64% of women currently meet the minimum recommendations for fruit and vegetable intake. Cancer Care Ontario vice-president Dr Terry Sullivan maintains that if the message about nutrition does not get through, new cancer cases could increase by two-thirds over the next 20 years.

BAD EATING, BAD HEALTH
The report asserts that unhealthy eating, obesity and physical inactivity may be responsible for 30% of cancers in the developed world and estimates that 16,000 cancers in Ontarians could be prevented annually by avoiding these risks. (The table shows where evidence is strongest.) These are good convincing numbers to throw around when discussing nutrition with your patients.

What to eat has become a more complex issue in recent years. Dr David Jenkins, Director of the St Michael's Hospital Clinical Nutrition and Risk Factor Modification Centre in Toronto, helps people control chronic disease through lifestyle alteration with a focus on diet. He bemoans the loss of entire food groups in the typical diet of the 21st century, from legumes to whole grains to leafy vegetables. "People spend only a couple of hours a week shopping for food and they look for products that can be prepared quickly, often in a microwave," he says. A survey conducted by medical students in his centre found that in only 10-15% of households did one person shop for the whole household. Fragmented shopping and fragmented eating make it difficult to create a balanced diet.

Here's what to tell your patients about nutrition For people of the same age, there are 25% fewer deaths from heart disease, stroke and cancer among those who eat lots of veggies -- five portions or more a day. So what's a portion? Vegetables: Two large tablespoons. Fruit: One large piece (banana, apple, orange) or two small ones (plums, tangerines, kiwis) Vegetables: Eat as much of as many portions as you like -- especially greens. They're best fresh but they age quickly, losing nutritional value. A week old is too old. Frozen food is generally frozen within hours of being picked and retains more nutrition. Cook veggies lightly -- steam or stir-fry. Pressure cookers retain the most nutrients. Fruit: A couple of portions a day. Carbs: Substitute grains (oatmeal, whole wheat bread, brown rice) and legumes (peas and beans) for potatoes, pasta and white rice. And eat them every day -- carbohydrates supply half the body's calories. Meat, fish, poultry, butter: mix and match if you eat meat every day. Try fish a couple of times a week -- but not farmed salmon more than once a month because of PCB contamination. Wild salmon's OK but pricey. Tuna contains mercury. Use olive oil as a butter substitute from time to time. Eggs and milk: Eggs, long demonized, are back in the nutritionist's good book. An egg makes a better breakfast than a donut. A glass of whole milk, on the other hand, contains as much saturated fat as four strips of bacon. Go low fat or use a calcium supplement. Alcohol: A glass of wine, an ounce of alcohol or a beer a day -- but no more. Multivitamins: Take one a day as a protective, not as a substitute for good eating. Don't go high-end, pharmacy brands are fine.