What makes mine unique is the fact that I have fruit and vegetables at the bottom (right above the need for daily exercise and fluid consumption). Although people may disagree with this decision, I made it based on evidence showing a strong association between higher intake of fruit and vegetables and decreased incidence of chronic disease:
- Higher intake of fruit and vegetables may be protective against cardiovascular disease (Liu et al, Am J Clin Nutr, 2000;72:922–8)
- The risk of some chronic diseases may be lower at higher dietary flavonoid intakes (Knekt et al, Am J Clin Nutr, 2002;76:560–8)
- Fruit and vegetable consumption is inversely associated with the risk of Coronary Heart Disease (Dauchet et al, J. Nutr. 136: 2588–2593, 2006)
- Greater vegetable and fruit intake is associated with a lower risk of breast cancer (Zhang et al, Int J Cancer, 2009;125,1:181-8)
- High total fruit intake and certain fruit and vegetable intakes may be associated with a reduced risk of colorectal adenomas (Wu et al, J Nutr, 2009; 139,2:340-4)
- In a review of 200 epidemiological studies, strong evidence was found to support the protective effect of fruit and vegetables. For most cancer sites, persons with low fruit and vegetable intake experience about twice the risk of cancer compared with those with high intake, even after control for potentially confounding factors (Block, Patterson & Subar, Nutrition and Cancer, 1992; 18,1: 1 - 29)
- Fruit and vegetable consumption reduces incidence of cancer and cardiovascular disease (van't Veer et al, Public Health Nutrition, 2000, 3:103-107)
Fruit contributes vitamins A, C, some B vitamins as well as some minerals. Dried fruit may contain iron. This section contains all whole fresh fruit and frozen fruit (which should be the priority and majority of fruit consumption) even though it can also include dried fruit, whole fruit juices, canned fruit (in order of health-promoting capacity).
Further, I have a separate category for leafy green vegetables additional to the foundational vegetable recommendations. My new quote that I tell my clients and students is "Let thy greens be thy medicine and thy medicine be thy greens". Leafy greens are chock-full of macro- and micronutrients, including calcium, fiber, folate, vitamins C, B6, B2, E, potassium, manganese, magnesium, phytochemicals (such as lutein, beta-cryptoxanthin, zeaxanthin, beta-carotene). This category of vegetables include kale, collard greens, spinach, mustard greens, beet greens, turnip greens, romaine lettuce, bok choy, Swiss chard, rainbow chard, Brussels sprouts, sea vegetables, broccoli, Napa cabbage. See my previous blog, The Greatness of Greens, for more about the undeniable superhero-esque power!
- Consumption of vegetables, green-yellow and green leafy vegetables was inversely associated with the risk of hepatocellular carcinoma (Kurahashi et al, Br J Cancer, 2009; 100,1:181-4)
- Kale demonstrates excellent absorbability of calcium (Heaney & Weaver, Am J Clin Nutr, 1990; 51,4:656-7)
- Lutein, a powerful antioxidant that protects the eyes against macular degeneration is bioaccessible from leafy greens (Chandrika et al, J Nutr Sci Vitaminol, 2010; 56,3:203-7)
- Dietary supplementation with leafy vegetables may be useful for protecting cells from lipid peroxidation and oxidative DNA damage (Kim et al, J Med Food, 2009;12,4:877-84)
- Significant decreased cancer risk found with increased carotenoid intake from green and yellow vegetables (Colditz, et al, Am J Clin Nutr, 1981, 41: 32-36)
- Deficiency of folate, a vitamin that is abundant in leafy greens, induces and accelerates carcinogenesis (Duthy, J Inherit Metab Dis, 2010 [Epub ahead of print])
- High combined intakes of vitamins C and E, beta-carotene, beta-cryptoxanthin, and lutein-zeaxanthin from food, or a diet high in their food sources (like leafy greens), may protect against cumulative DNA damage in radiation-exposed persons (Yong et al, Am J Clin Nutr, 2009, 90,5:1402-10)
- Better behavioural outcomes in adolescents are associated with a higher intake of fresh fruit and leafy green vegetables (Oddy et al, Prev Med, 2009; 49,1:39-44)
Moving on up the pyramid...
Whole grains are the backbone of the plant-based diet as they contribute calories, fiber, protein, iron, B vitamins, trace nutrients in whole grains. This category includes: corn, brown rice and sprouted tortillas; whole grain breads; cereals (i.e. oats); bulgur; brown rice; couscous; millet; quinoa; whole grain pasta; polenta; wheat berries; popcorn; wheat germ and bran.
Legumes provide a supporting role in the diet. They are used extensively in international cuisines and provide protein, fiber, iron, calcium, zinc, selenium. Legumes include cooked & dried beans (adzuki, anasazi, black, black-eyed peas, cannellini, chickpeas, great Northern beans, kidney beans, lima beans, navy beans, pinto beans, soybeans), lentils, peas, split peas, and soy products (tempeh, tofu).
At the top of my pyramid, I have listed high fat whole foods, dairy substitutes (which are great sources of fortified vitamins B12, D, and sometimes calcium), and whole food sweetened treats (which can be done by using dates, date syrup, pure maple syrup and other fruits). High fat whole foods refer to olives, avocado, nuts and seeds, which are important in order to consume adequate omega 3 fatty acids, monounsaturated fatty acids, fiber, protein, fat, iron, calcium, and trace minerals. All of these items should be used sparingly and less in situations where weight loss is a goal or when there has been a diagnosis of heart disease, diabetes, high cholesterol or other metabolic conditions.
Overall, I hope that this pyramid is used as a guideline. The serving sizes are not necessary to perfect...it is more important to look at it as a way of proportioning out what a day's worth of food should look like. The foods closer to the bottom should be a mainstay or foundation of intake and those near the top are to be used as support.
I also highly recommend everyone consume a vitamin B12 supplement of either 10μg daily OR 2,000μg weekly and have their serum vitamin D levels checked. If your serum 25 hydroxy D levels are less than 35 ng/mL, it is necessary to increase sun exposure (during peak hours and with no sunscreen for a few minutes a day...without allowing any reddening of the skin to occur) and possibly add supplemental D2. Please speak with your physician to address this issue.