Dr. Mark Hyman & Functional Medicine

One of my favorite lecturers during my program at IIN was Dr. Mark Hyman, author of The UltraMind Solution, Ultrametabolism, The UltraSimple Diet, and Ultraprevention.  He is a Medical Doctor (yup, educated at an accredited institution and fully trained) and when he first started working in the ER, he thought he was above taking care of himself because he was a doctor. He became very sick and ended up healing himself through natural methods including heavy metal detoxification and diet changes.  

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He now practices functional medicine, an emerging system of medicine that addresses and solves the root cause of a disease vs. just masking a disease's symptoms.  Common sources of disease are hidden allergens, infections, environmental toxins, inflammatory foods, and stress.  Dr. Hyman's lecture really resonated with me because I'm not a big fan of pharmaceuticals and OTC medicine.  Medications are 99.9% of the time a band-aid not a true treatment of the disease or disorder.

Below is a great article Dr. Hyman wrote on functional medicine and autoimmune disease.  A great simile he uses to describe functional medicine is: 

"Functional medicine is a different way of thinking about disease that helps us understand and treat the real causes of inflammation instead of finding clever ways to shut it down. Medicine as it is practiced today is like taking the battery out of a smoke detector while a fire burns down your house!"

What are you thoughts on functional medicine?  Have you heard of Mark Hyman before?

How to Stop Attacking Yourself: 9 Steps to Heal Autoimmune Disease

Inflammation is "hot" topic in medicine. It appears connected to almost every known chronic disease -- from heart disease to cancer, diabetes to obesity, autism to dementia, and even depression. Other inflammatory diseases such as allergies, asthma, arthritis, and autoimmune disease are increasing at dramatic rates. As physicians we are trained to shut off inflammation with aspirin, anti-inflammatory medication such as Advil or Motrin, steroids and increasingly more powerful immune suppressing medication with serious side effects. But we are not trained to find and treat the underlying causes of inflammation in chronic disease. Hidden allergens, infections, environmental toxins, an inflammatory diet, and stress are the real causes of these inflammatory conditions.

Autoimmune diseases, specifically, now affect 24 million people and include rheumatoid arthritis, lupus, multiple sclerosis, thyroid disease, inflammatory bowel disease, and more. These are often addressed by powerful immune suppressing medication and not by addressing the cause. That's like taking a lot of aspirin while you are standing on a tack. The treatment is not more aspirin or a strong immune suppressant, but removing the tack.

It you want to cool off inflammation in the body, you must find the source. Treat the fire, not the smoke. In medicine we are mostly taught to diagnose disease by symptoms, NOT by their underlying cause. Functional medicine, the emerging 21st paradigm of systems medicine teaches us to treat the cause, not only the symptoms, to ask the question WHY are you sick, not only WHAT disease do you have.

I recently participated in a group discussion with a conventional doctor, a rheumatologist, and patient with an autoimmune disease, and one of my patients who was cured of a complex autoimmune disease by addressing the causes. The focus of the other doctors, however, was on how to suppress the inflammation with medication, not finding and treating the cause. Functional medicine is a different way of thinking about disease that helps us understand and treat the real causes of inflammation instead of finding clever ways to shut it down. Medicine as it is practiced today is like taking the battery out of a smoke detector while a fire burns down your house!

When my patient described how he cured his autoimmune disease by finding and eliminating the causes of inflammation in his diet and environment, it was dismissed as a "spontaneous remission." In the face of a paradigm-shattering medical case, these docs were hardly curious and quickly dismissive, describing what was shared as anecdotal.

My patient on that panel, a hard-working 46-year old father of three was once so inflamed he could barely function. By treating the underlying causes of his inflammation he is now in vibrant good health, enjoying his life with his kids and fully capable of caring for them.

Stories like these (and the many others I have shared in my blogs, books, and on television) are not anecdotes but a giant compass pointing us in the direction we should be looking to find answers to our health problems.

In today's blog, I will explain what autoimmunity is, how inflammation spirals out of control, describe some of the underlying causes for these fires in the body, and provide you with nine steps to cool the fires of inflammation and overcome conditions that range from allergies to arthritis and more.

Autoimmunity: What it is and How it Occurs

We are facing an epidemic of allergic (60 million people), asthmatic (30 million people) and autoimmune disorders (24 million people). Autoimmune diseases include rheumatoid arthritis, lupus, multiple sclerosis, psoriasis, celiac disease, thyroid disease, and the many other hard-to-classify syndromes in the 21st century. These are all autoimmune conditions, and at their root they are connected by one central biochemical process: A runaway immune response also known as systemic inflammation that results in your body attacking its own tissues.

Your immune system is your defense against invaders. It is your internal army and has to clearly distinguish friend from foe -- to know you from other. Autoimmunity occurs when your immune system gets confused and your own tissues get caught in friendly cross-fire. Your body is fighting something -- an infection, a toxin, an allergen, a food or the stress response -- and somehow it redirects its hostile attack on your joints, your brain, your thyroid, your gut, your skin, or sometimes your whole body.

This immune confusion results from what is referred to as molecular mimicry. Conventional approaches don't have a method for finding the insult causing the problem. Functional medicine provides a map to find out which molecule the cells are mimicking.

Interestingly, autoimmune disorders occur almost exclusively in developed countries. People in poor nations without modern amenities like running water, flush toilets, washing machines, and sterile backyards don't get these diseases. If you grew up on a farm with lots of animals, you are also less likely to have any of these inflammatory disorders. Playing in the dirt, being dirty, and being exposed to bugs and infections trains your immune system to recognize what is foreign and what is "you."

In this country, autoimmune diseases when taken all together are a huge health burden. They are the eighth leading cause of death among women, shortening the average patient's lifespan by eight years. The annual health care cost for autoimmune diseases is $120 billion a year representing nearly twice the economic health care burden of cancer (about $ 70 billion a year). (i)

Unfortunately, many of the conventional treatments available can make you feel worse. Anti-inflammatory drugs like Advil, steroids, immune suppressants like methotrexate, and the new TNF-alpha blockers like Enbrel or Remicade can lead to intestinal bleeding, kidney failure, depression, psychosis, osteoporosis, muscle loss, and diabetes, not to mention overwhelming infection and cancer.(ii)

When used selectively these drugs can help people get their lives back. But they are not a long-term solution. They shouldn't be the end of treatment, but a bridge to cool off inflammation while we treat the root cause of the disease.

There is another way to deal with autoimmune conditions. Let me share the same story I told the doctors on that panel.

Recovering from Autoimmunity: Addressing the Root Causes of Inflammation

My patient Sam ended up on a long misadventure through the medical system before he came to see me. For years he went from doctor to doctor getting all kinds of labels for his problems but no real help in treating them.

This hard-working, once healthy trade professional had suddenly developed a series of inflammatory conditions including chronic sinus and prostate infections. Many doctors gave him many antibiotics for these infections.

Shortly thereafter, he developed severe chest pains and went to the emergency room. While he was there, doctors found swollen lymph nodes and told him he had lymphoma, a form of cancer. For three weeks he lived in despair until the biopsy results came back. It turned out he didn't have cancer but an autoimmune disease. Which autoimmune disease? The doctors weren't quite sure ...

He had many abnormal blood test results -- like low white blood cell and platelet counts, high levels of auto-antibodies of all types (antibodies that attack our own tissues), high immunoglobulins (the foot soldiers of the immune system), and autoimmune thyroid disease. But doctors had a hard time putting their finger on what was wrong. They couldn't label him.

Meanwhile, Sam developed metabolic syndrome and weight gain (pre-diabetes) as a result of the runaway inflammation in his body.

Here is a quote from one his specialist's notes:

"Whether he has lupus or Sjogren's syndrome is a bit unclear. Regardless, he merely needs observation and no therapeutic intervention at this time."

This unfortunately is all to common. What exactly did they plan to observe, how bad he felt? Or would they just wait for him to get worse before intervening?

That's when he came to me. Using a functional medicine approach, a new way of thinking about the underlying causes and imbalances in chronic disease, I began by asking Sam some simple questions. Then I went hunting for toxins, allergens, and infections -- all common causes of inflammation -- and found the real causes of his symptoms. He had taken so many antibiotics that altered his gut flora or bacteria and promoted yeast overgrowth. Fungus and yeast flourished in his body, growing between his toes, on his toenails, in his crotch, and scalp. He had Helicobacter pylori bacteria in his gut. He had a leaky gut and reacted to many foods, including dairy and gluten. He was exposed to toxins at his job and had high levels of mercury. And he had chronic sinus infections.

So we went to work cleaning house. I treated his yeast with anti-fungals and the H. pylori with antibiotics, got rid of his food allergies, fixed his gut, detoxified him from metals, and cleaned up his sinuses. Then I helped heal his immune system by supporting it with nutrients. I gave him zinc, fish oil, vitamin D, herbs, and probiotics, and put him on a clean, whole-foods, allergen free, anti-inflammatory diet.

At his next follow-up visit, I asked Sam how he was doing, expecting him to say that he felt a little better. However, his response surprised even me. He said he felt fine.

"What about the fatigue?" I asked.

"I have great energy."

"What about the bloating and gas?"

"Nope."

"What about the reflux?"

"Gone."

"What about your sinuses and chronic phlegm?"

"All clear."

"What about your memory and concentration problems?"

"All better."

And he lost 15 pounds.

When his labs came in, they confirmed what he told me -- they were all back to normal. His white cells increased and his immune markers calmed way down.

Sam's results simply reflect the application of a new model of thinking about problems called Functional medicine -- it's a way to get to the root of health problems and treat the underlying causes of what ails you instead of suppressing symptoms with medications.

If you have an autoimmune disease, here is what you need to think about and do.

Nine Steps to Treating Autoimmune Disease

1. Check for hidden infections -- yeast, viruses, bacteria, Lyme, etc. -- with the help of a doctor, and treat them.

2. Check for hidden food allergens with IgG food testing or just try The UltraSimple Diet, which is designed to eliminate most food allergens.

3. Get tested for celiac disease, which is a blood test that any doctor can do.

4. Get checked for heavy metal toxicity. Mercury and other metals can cause autoimmunity.

5. Fix your gut. For details, see my blog on irritable bowel syndrome.

6. Use nutrients such as fish oil, vitamin C, vitamin D, and probiotics to help calm your immune response naturally.

7. Exercise regularly -- it's a natural anti-inflammatory.

8. Practice deep relaxation like yoga, deep breathing, biofeedback, or massage, because stress worsens the immune response.

9. Tell your doctor about Functional medicine and encourage him or her to get trained -- go to www.functionalmedicine.org for more information and to get a copy of the Textbook for Functional Medicine.

Give these steps a try -- and see if you don't start feeling less inflamed. As I said earlier, the answers are right in front of you. Treat the underlying causes of your illness and you will begin to experience vibrant health once more.

Now I'd like to hear from you...

Have you been diagnosed with an autoimmune disease?

How is your doctor treating you?

Have you been frustrated by the medical advice that you've been given?

What steps have you taken to get to the root of the problem, and what have your results been?

Please leave your thoughts by adding a comment below.

To your good health,

Mark Hyman, M.D.

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How to Read those Produce Labels

Sometimes I get an apple with a sticker on it and it just won't come off.  It's not meant to be a pest but to be informative. On the sticker may be the name of the specific type of apple (or whatever produce) you may be eating.  More importantly, what's also on there is the price look up (PLU) code.  This code is a really important tool in identifying the way that your produce was grown.  There's actually a whole site devoted to helping you decipher fruit labels.

There are really only 4 types of stickers to remember and 3 categories. Labels with:

4 digits beginning with 3 or 4 are conventionally grown, non-GMO produce.  This produce has been sprayed with weed killers and chemical pesticides but is not genetically modified

5 digits beginning with 8 means that the produce is genetically modified (boo! hiss!)

5 digits beginning with 9 means it is organic! (refer to my post on the Dirty Dozen to see what foods to prioritize in buying organic)

Here are examples of different tomatoes:

~Conventionally grown with pesticides and plant killers but not GMO	~Conventionally grown with pesticides and plant killers but not GMO
∅ Genetically modified! Don't buy it!	♥ Organic

This may be confusing but very important when you are buying produce at the supermarket!  Here's an easy little rhyme I learned to help you remember all this information:

"8, we hate.........4, is poor.........9, is mine."

Happy Shopping!

Just Say "No" to GMO's

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Genetically modified organisms, GMO's for short, are a loaded topic. A genetically modified organism is a plant or animal that has had genes from other organisms inserted into its DNA structure.  A huge reason for the popularity of GMO's is because of agriculture.  Some people think GMO's are going to save our planet from world hunger.  By modifying plants, they can grow under harsher conditions and/or more quickly.  The same with animals.  For instance, an "antifreeze" gene from fish has been introduced to tomatoes so that they can grow in colder weather.  And salmon has a gene from another fish, called a pout, that enables it to continuously produce growth hormone....um steroids anyone?  

The popularity of GMO's in the US is unfortunately growing.  You'll be surprised to learn what countries already have restrictions on GMO's.  See the list below (courtesy of www.purezing.com):

The following countries have banned or restricted the import, distribution, sale, utilization, field trials and commercial planting of GMO’s:

• Africa: Algeria, Egypt
• Asia: Sri Lanka, Thailand, China, Japan, Phillipines
• Europe: The European Union, Norway, Austria, Germany United Kingdom, Spain, Italy, Greece, France, Luxembourg, Portugal
• Latin America: Brazil, Paraguay
• Middle East: Saudi Arabia
• North America: Maryland has banned GE (genetically engineered) fish and North Dakota and Montana have filed bans on GE wheat. The Municipalities of Burlington, Vermont (declared a moratorium on GE food), Boulder, Colorado (bans on GE crops) and the City and County of San Francisco (urged the federal government to ban GE food) are the only towns or states to take some sort of stand against plants, animals, foods, crops and body products that are, or contain Genetically Modified Organisms.
  NOTE: The U.S. government, and the FDA do not require anything Genetically Modified to be identified on ingredient lists. Genetically Modified foods and products are in widespread use and distribution throughout the U.S.
• Pacific: American Samoa, Cook Islands, Fiji, Kiribati, Federated States of Micronesia, Marshall Islands, Nauru, Papua New Guinea, Samoa, Solomon Islands, Tonga, Tuvalu, Vanuatu, Australia, New Zealand

Percentage of crops that are Genetically Modified in the U.S.:

• Soy (85%)
• Cotton (Cottonseed) (76%)
• Canola (75%)
• Corn (40%)
• Hawaiian papaya (more than 50%)
• Zucchini and Yellow Squash (small amount)
• Quest brand tobacco (100%)

GMO's are controversial. (What topic on this blog hasn't been?)  Scientists state that there are no negative side effects from eating genetically modified plants and animals.  What does your gut think? Mine says that we are trying to play the role of God (or whoever is in charge).  If tomatoes were meant to grow in the cold weather, they would!  And if fish were meant to grow faster, they'd be able to!  But alas, they do not.  

How can someone believe that slicing and dicing the genetic makeup - essentially, the being - of a plant or animal do not change them and how they react in our bodies?  My suggestion is to avoid GMO's.  Unfortunately, it's hard to identify what is a GMO or what products contain it. There is no law in the US that requires for GMO's to be labeled.  I have seen some products state that they are GMO-free.  Also, by default, organic produce and packaged food do not contain GMO's.  Here is a shopping guide with a ton more information.  As consumers, we vote for what we want to buy every time we are at the register.  Make wiser choices and companies will respond!!  Take action!

Check back tomorrow for a post on how to read those numbered produce stickers at the grocery store.

New Baby Food Diet

Have you thought you'd seen it all in terms of fad mono diets?  There's tons of diets based on eating a single food or food group.  These include the grapefruit diet, the legendary cabbage soup diet, the popular cookie diet, and even the fried chicken diet!  The basis of a mono diet is that a person can only eat one, single thing for a certain period of time.  Then due to human nature, the person will get so bored of eating that one thing that they won't want to eat anymore. So they stop eating and lose weight.  But when a person returns to a normal diet, they start eating EVERYTHING due to deprivation and then gain all the weight back and likely some more.  Despite the predictable failed outcome to these diets, they continue to reappear in new forms.  The most recent being in innocent baby food form. 

This may make the most sense of all the diets I mentioned.  Pureed organic baby food does not cost that much and there is a lot of variety including vegetables, fruits and lean meat.  Unfortunately, it is still not enough for a person to sustain themselves on. The nutrients available in baby food is made for, you guessed it, babies. Cute little 10 pound creatures. Not adults.  Plus at the end of the day, the stuff is still processed.  So I'd ask that you stay away from this diet and any of these fad mono diets.  However, I do have a tip around baby food that I learned from fellow holistic health counselor, Liz of Mind Body Basics.  For those of us who can't seem find a great snack on the go or when traveling, bring along a pouch of baby food like the one in the above picture and when hungry, slurp it like a Go-gurt.  It's a convenient, cheap and organic snack.  Happy slurping!

Quote for the Week: Overwhelmed

It's been a remarkable weekend. I am officially a certified holistic health counselor! There were many quotable quotes this past weekend from teachers, students and past graduates.  One really resonated and stuck with me and I will be using it for a while.

"Overwhelmed is about your not being up to speed with what you asked the universe for."

Attention. The Systems are Down.

Continuing the conversation from my post on Friday…

The article gave 4 tips. Essentially, eat more vegetables and fruits and less fats and meat. Oh, and exercise. Apparently, we're not doing that. Is this news? The rate of obesity has been on the rise for almost a century. The public hears recommendations that experts and the USDA suggest, but for some reason, they're not following them. Why not?

The article touches lightly on it. “For Americans today, healthy eating is like swimming upstream.” The system does not allow for people to make the best choices. Sheer human will power has something to do with our failed health but I’d say the majority of it has to do with the systems that touch upon food. The systems I am covering are very complicated. There are multiple facets that would take years and years of blog posts to cover. What I’m offering are my high level thoughts on how they impact our inability to make healthy choices.

Food

The food system is completely distorted and extremely complex in the US. The government has a very large hand in the food industry and that really shouldn’t be the case because it has its other hand(s) in making laws, the country’s economic wellbeing, and a much much more. The agenda of government sponsored groups are a bit hazy. Who are they working for? The people? The industry lobbyists? The US economy? I’ll let you decide for yourself.

The reality of the situation is that vitamin and antioxidant rich fruits and vegetables are not subsidized by the government while soy, corn, wheat, milk and meat are. And because of the way those foods are subsidized, farmers and livestock growers try to produce as much bulk as possible, sacrificing quality for quantity. The citizens’ health and wellbeing are not concerns. Shouldn’t the food system and the food pyramid be based on healthy BMI’s or blood pressure and not $$$?? There are many more aspects of food and politics. If you are interested, I’d suggest one Marion Nestle’s book Food Politics and her very informative blog-www.foodpolitics.com.

Education 

The issue with the education system is 3-fold.

1) Food education itself is minimal. What I remember learning about food was a brief overview of the food pyramid and minimal cooking experience in a 7th grade Home Ec class where I remember making cookies and cakes vs. kale or hummus.

2) School food is an atrocious excuse for food. It's the garbage pail for the subsidized food system.  If a student is receiving any adequate information on healthy eating, he or she experiences an extreme disconnect once they get into the cafeteria. School food needs to align with what we teach our children and we need to teach our children correctly.

3) Physical education aka gym class is being eliminated or drastically cut from many schools in favor of more classes to meet demands of higher test standards. This is counterproductive, people! No kid is going to sit through 3 hours of class without fidgeting or acting up-then they get diagnosed with ADD or ADHD.  They are full of boundless energy and our schools need to embrace it. Let's allow our kids to release that energy so that when they get back into the classroom, they can learn!

Economy

We are a capitalist society. Although it's built our country to becoming pretty powerful, our economy has us prioritizing money over public health. This happens every day in America. Our children are preyed upon by big food corporations with artificially colored cereals and gummies and with funny, entertaining commercials for cookies and candies. Restaurants and fast food chains offer the biggest bang for the buck with big portions or low cost, low quality foods. Some doctors have even admitted that their practice is a business and if their patient wants to come in for a second bypass surgery, they’ll let them. Prevention and taking vitamins is not encouraged because it doesn’t make any money, honey! When the economic engine of our country is run by drivers with $ signs in their eyes, our health takes a back seat.

Society

Society is broken. Our values are no longer driven internally or by our family. Instead, we are constantly reaching out externally to learn and adopt unhealthy values. One such value is the value of beauty. Our society’s value of beauty usurps that of emotional intelligence and logical intelligence as well as just being a damn good person. Our standard of beauty is unattainable with ever-shrinking Barbie dolls being an ideal image to girls AND boys. Beauty ads have models airbrushed to perfection. Many of us grow up under the idea that we need to become physically perfect. We ignore the bags under the skinny girl’s eyes or the steroids that the bodybuilder is injecting into himself.

Another value is the value of our selves! Society says it’s a “no-no” to concentrate on you. No matter if you are a mom, dad, daughter, son, student, dog owner, entrepreneur, accountant, line cook, psychologist, or even a doctor, you are not a priority to you.

Society is complex and I only brought up 2 values-keep the conversation flowing. This is something to change overnight. It will take a generation or two. Don’t your grandparents or parents still have the same values they grew up with?

Healthcare  

Yikes! This is that big dustball that keeps getting swept under the bed. The difference this time is that Obama is cleaning house! There are a multitude of issues with the healthcare system, only some of which is being addressed so far with the reform. Our healthcare system is not about health. Some, like my teacher Joshua Rosenthal, would say it's a disease management system.  Let's practice prevention-not reactional therapies!  

We need to take the reins back and take control of our environment and change them so they support a healthier lifestyle-not butt heads with it. Start with yourself. What is one thing you can do to better your health? Then move onto family and friends. How can you support and/or educate them to eat and live healthier? Then go on to your community. Can you talk to the PTA and start a wellness committee at your school? Maybe start a community garden? Change the local school lunch program? The possibilities are boundless. You don’t need to do any large like eradicate pesticide use or hormone raised meat. Start with ONE small thing. Maybe buy the cookies without the trans fats for your family next shopping trip and let them know why you are doing it. Take a “ME” day so that you are more focused at home and work and are a more pleasant person to be around.

Newsflash! America, We're Fat...

I just read an article (see below) that was full of "the latest" information on obesity.  Apparently, it's taken more than half of the US population to become overweight and more than of half deaths to be attributed to heart disease, cancer, and strokes (all lifestyle diseases strongly linked to obesity) before an "expert panel" could declare that obesity is "the single greatest threat to public health in this century." It's 2010!  And a half!  You mean it's taken them 10.5 years into the 21st century to determine this?  If you remember my post earlier this month, in 2000, 22 states had an obesity rate of 20% or more in their state's population.  A reminder that being obese means to have a BMI over 30 and being overweight is to have a BMI between 25 and 29.9.  I bet that the classification of 30+ BMI was not even established 20-30 years ago.  When they added this new range to the index, if anything, that should have been a red flag!  So, how is it NOW that obesity is declared such a large threat?

Alright, enough of my frustration on our country's ridiculous need for validation through studies and analysis versus common sense and for it to hit a breaking point before it will do anything.  Take a look-see at the article and let's chat tomorrow about what they recommend we should do about this humongous threat and of course, my thoughts on their thoughts. 

Happy Friday!



Panel: Obesity is century's greatest public health threat

By Nanci Hellmich, USA TODAY

 

Obesity is "the single greatest threat to public health in this century," an expert panel declared in a report Tuesday that urges Americans to slash calories and increase their physical activity.

An advisory committee for the 2010 Dietary Guidelines for Americans calls on people to cut back on added sugars and solid fats (butter, marbled meats) and to follow a more nutrient-rich, plant-based diet.

The report is based on the latest scientific evidence and was prepared by a 13-member panel of national nutrition and health experts. The public now has 30 days to comment at www.dietaryguidelines.gov.

The final 2010 dietary guidelines will be released later this year by the U.S. Department of Agriculture and Department of Health and Human Services.

About two-thirds of adults and one-third of children in the United States are overweight or obese. The advisory committee highlighted four major steps:

• Reduce excess weight and obesity by cutting calorie intake and increasing physical activity.
• Shift to a more plant-based diet that emphasizes vegetables, cooked dry beans and peas, fruits, whole grains, nuts and seeds. Increase the intake of seafood and fat-free and low-fat milk and milk products, and eat only moderate amounts of lean meats, poultry and eggs.
• Significantly reduce intake of foods containing added sugars and solid fats, which contribute about 35% of the calories in the American diet. Cut sodium intake gradually to 1,500 milligrams a day and lower intake of refined grains, especially those with added sugar, solid fat and sodium.
• Meet the 2008 Physical Activity Guidelines for Americans. Those recommend that adults get at least 2½ hours of moderate-intensity physical activity each week, such as brisk walking, or 1¼ hours of a vigorous-intensity activity, such as jogging or swimming laps, or a combination of the two types. Children and teens should do an hour or more of moderate-intensity to vigorous physical activity each day.

The report calls for many changes in the food environment, including:

• Improve nutrition literacy and cooking skills, and motivate people, especially families with children, to prepare healthy foods at home.
• Improve the availability of affordable fresh produce through greater access to grocery stores, produce trucks and farmers' markets.
• Encourage restaurants and the food industry to offer health-promoting foods that are low in sodium; limited in added sugars, refined grains and solid fats; and served in smaller portions.

The dietary guidelines were first published in 1980 and are updated every five years. They're used for government nutrition programs and education, as well as by dietitians and health professionals to help educate people about eating healthier.

"Basic nutrition advice hasn't changed much over the 30 years that the dietary guidelines have been published, but what has changed is it is harder and harder to eat well," says Margo Wootan, director of nutrition policy at the Center for Science in the Public Interest, a consumer group based in Washington, D.C.

"For Americans today, healthy eating is like swimming upstream. It's not that you can't do it, it's just it's so hard," she says. "Without changing the food environment, people don't stand a chance of following the advice in the dietary guidelines."

Three steps to lower your calories, she says: Cut portions, eat less when dining out and drink fewer sugary beverages.