Eat, Drink, and Be Healthy: The Harvard Medical School Guide to Eating

Overall score

Scientific accuracy

Reference accuracy

Healthfulness

How hard would it be to apply the book's advice? Fairly easy

Book published in 2017

Published by Free Press

Updated and expanded Edition, Paperback

Review posted April 8, 2021

Primary reviewer: Seth Yoder

Peer reviewer: Travis Masterson

Table of contents

1. Introduction
2. Scientific accuracy
3. Reference accuracy
4. Healthfulness
5. Most unusual claim
6. Other
7. Conclusion
8. Updates

Claim 1

Summary of claim: Fruits and vegetables, except for potatoes, provide many health benefits including decreased risk of heart attack, stroke, and the development of diabetes.

Supporting quote(s) and page number(s)

“A diet rich in fruits and vegetables can decrease the chances of having a heart attack or stroke or developing diabetes…” (pg 150)

“I am not including potatoes and corn in the vegetable category, even though they are among the most popular ‘vegetables’ in America. In your digestive system they act more like carbohydrates.” (pg 152)

“A diet that includes plenty of fruits and vegetables can help control or even prevent high blood pressure and high cholesterol, two of the main precursors of heart disease and stroke.” (pg 155)

“More than two hundred studies have shown that people who eat plenty of fruits and vegetables decrease their odds of having a heart attack or strokes, of developing a variety of cancers, or suffering from constipation or other digestive problems, Yet the same body of evidence shows that potatoes don’t contribute to this benefit and may even lead to poor health.” (pg 169)

Criterion 1.1. How well is the claim supported by current evidence?

4 out of 4

This item received a score of 4, indicating the claim is strongly supported by current evidence. With respect to cardiovascular diseases, a 2013 Cochrane Systematic Review found that, while clinical trials were few, the studies showed a favorable effect on CVD risk. Looking at prospective cohort studies, a 2014 meta-analysis determined that an increased fruit and vegetable intake was associated with mortality from any cause, but particularly for CVD.  Similarly, a 2014 meta-analysis of cohort studies showed an inverse correlation with risk of stroke. A 2017 meta-analysis focusing on CVD and fruits and vegetables concluded CVD was also inversely correlated with fruit and vegetable intake. A 2017 review examining the dose-response relationship of fruits and vegetables estimated that in 2013 approximately 5.6 million premature deaths worldwide were due to inadequate fruit intake and 7.8 million premature deaths were due to inadequate vegetable intake. However, these numbers included deaths from coronary heart disease, stroke, cardiovascular disease, and cancer.

In terms of diabetes, a 2016 meta-analysis suggests that a higher intake of fruits and vegetables —  particularly berries, green leafy vegetables, yellow vegetables, cruciferous vegetables or their fiber — is associated with a lower risk of type 2 diabetes. A dose–response analysis from 2014 indicated a 6% lower risk of type 2 diabetes for every serving of fruit per day and a 13% lower risk of type 2 diabetes for every 1/5th serving per day of green leafy vegetables.

The book also makes the case that some items that we might understand as vegetables in a culinary sense, such as potatoes and corn, do not have the protective properties of colored, leafy vegetables, and should be considered more of a starch along the lines of rice or wheat rather than a “vegetable.” Importantly, EDBH points out that these vegetables are better than nothing but makes the suggestion to replace these with other choices when possible. The scientific literature supports this idea. Potatoes do not appear to confer the same benefit of risk reduction to cardiovascular disease and diabetes that other vegetables possess, according to a 2016 systematic review.  Potatoes prepared as French fries may even lead to an increased risk of type 2 diabetes, likely in part due to the use of saturated fats for battering and frying.

Criterion 1.2. Are the references cited in the book to support the claim convincing?

4 out of 4

This item received a score of 4 indicating that the references are convincing. For support of this claim, a variety of references are cited from reputable journals. The majority of these studies are observational studies and systematic reviews of observational studies. Although long term randomized controlled trials are preferable in evaluating nutritional claims, very often when studying chronic diseases such as cancer, heart disease, or diabetes these types of studies are all but impossible to conduct. Therefore, observational studies like prospective cohort studies that follow a population over a long period of time while carefully recording what they eat are the best evidence that is available. Additionally, EDBH acknowledges the limitations of the studies they cite.

We would like to note that EDBH was originally published in 2001 and has been revised and updated several times since then. Although many references for this claim have been updated others were not when they could have been. For instance, EDBH cites a 1999 trial on fruit and vegetable intake and risk of stroke, but there are more recent and more robust studies of this topic. However,  the general conclusion that would be reached is not much changed.

Criterion 1.3. How well does the strength of the claim line up with the strength of the evidence?

4 out of 4

This item received a score of four, indicating the strength of the claim aligns well with strength of the evidence.

EDBH is authored by a well-known career nutrition researcher, and it is evident. The text of EDBH never seems to overstate the claim. EDBH uses language similar to the studies that are cited, such as “decreased risk”, “odds”, and “chances.” This properly orients the reader to the strength of the research and avoids making the claim appear as a miracle cure or a revolutionary discovery.

Overall (average) score for claim 1

4 out of 4

Claim 2

Saturated fats and trans fats are damaging to the heart and overall health, while unsaturated fats are not.

Supporting quote(s) and page number(s)

“Saturated fats and trans fats are damaging to the heart and to overall health. Make the switch to foods or food ingredients that contain healthful unsaturated fats: monounsaturated fats like olive and canola oils and polyunsaturated fats like soy and corn oil.” (pg 106)

“Unsaturated fats are good for you, saturated fats aren’t so good, and trans fats are downright harmful.” (pg 106)

“Cutting back on all types of fat and eating more carbs does nothing to protect against heart disease and will ultimately harm some people. Instead, replacing saturated fats with unsaturated fats is a safe, proven, and delicious way to cut the rates of heart disease.” (pg 97)

Criterion 1.1. How well is the claim supported by current evidence?

4 out of 4

This claim received a score of four, indicating it is strongly supported by the current evidence.

To claim that dietary trans fat does not promote health and increases risk of heart disease is an uncontroversial statement today, because quite a bit of evidence has accumulated to support that contention. In the 1990s evidence was mounting that trans fat was as bad or even worse than saturated fat when it came to heart disease risk. In fact, the research indicated that trans fats increased levels of “bad” LDL cholesterol and decreased levels of “good” HDL cholesterol, both of which are important risk factors for heart disease. Since then, the evidence against trans fat has accumulated even more, with systematic reviews and meta-analyses on the subject supporting the findings that they increase risk of heart disease.

On the other hand, claims around  saturated fat and health outcomes have become hot button issues, particularly in fad diet communities, over the past few years. So what does the literature say about it? A 2020 Cochrane review on saturated fats states “reducing saturated fat intake for at least two years causes a potentially important reduction in combined cardiovascular events.” Similarly, a 2018 Cochrane review states that increasing intake of polyunsaturated fats (slightly) reduces risk of heart disease. Rather than trying to decrease one’s overall consumption of fat, it seems that replacing the saturated fat in the diet with polyunsaturated fats has a significant impact on heart disease risk.

The impact of monounsaturated fats is less clear, though, as there have been very few randomized controlled trials examining monounsaturated fats and their relationship to heart disease. Much of what is known comes from observational studies. A 2014 meta-analysis reviewing monounsaturated fats and heart disease finds no significant reduction in risk, although the same meta-analysis indicated the olive oil, which consists of mainly monounsaturated fatty acids, is significantly associated with a reduced risk of heart disease. This is consistent with a 2018 investigation of two cohort studies (Willett is one of the authors of these papers) showing that when plant and animal sources of monounsaturated fatty acids are separated, replacing trans fats, saturated fats, or carbohydrates with monounsaturated fats of plant origin reduces risk of heart disease while replacing them with monounsaturated fats of animal origin does not. According to the bulk of the literature, these dietary fat substitutions reduce heart disease risk by impacting the cholesterol levels in the blood.

EDBH focuses mainly on dietary fat and cardiovascular risk, bu   t briefly mentions some other maladies associated with dietary fat. One such malady is cancer. In that regard the Third Expert Report by the World Cancer Research Fund shows that there is very little evidence that fat is linked with cancer. What evidence is presented in the report suggests that there is limited evidence that saturated fat increases risk of pancreatic cancer. This weak connection between fat and cancer is noted appropriately in EDBH.

Criterion 1.2. Are the references cited in the book to support the claim convincing?

4 out of 4

This item received a score of 4 indicating that the references are convincing.

For those that may not know, Dr. Walter Willett is a prominent nutritional epidemiologist and has been involved with several widely-cited studies (such as the Nurses’ Health Study and the Health Professionals Follow-up Study), and authored many, many papers in the nutrition science field. Many papers he cites in support of this claim and elsewhere in the book are papers on which he is an author, however, he does often point out the limitations or the strength of the evidence to the reader.

Nevertheless, the evidence that is cited for this claim and others in the text are very widely-cited studies that are published in top-tier journals, such as the New England Journal of Medicine and JAMA. And although much of what is cited are observational studies, which we consider lower quality evidence that does not definitively demonstrate a cause-effect relationship, randomized controlled trials are also cited in support of EDBH’s dietary fat claims. These include the Lyon Diet Heart Study and the PREDIMED study, both of which are landmark trials that provide evidence that a diet low in saturated fats but high in unsaturated fats (Mediterranean diet) reduces the likelihood of cardiovascular events and improves mortality outcomes.

Dietary trials are cited for this claim, but so are large observational studies and review articles, providing robust support of the claim.

Criterion 1.3. How well does the strength of the claim line up with the strength of the evidence?

4 out of 4

This item received a score of four, indicating the strength of the claim aligns well with strength of the evidence.

The claim appears to be stated adequately and accurately reflects both the evidence presented in the text as well as the current body of literature that is available today.

Overall (average) score for claim 2

4 out of 4

Claim 3

Protein sources from plants and lean meats such as chicken or fish are likely more beneficial than protein from red and processed meat. Protein from soy, however, is less well-understood.

Supporting quote(s) and page number(s)

“[E]ating more protein from plant sources like beans and nuts, or from fish and chicken, and getting less from red meat and dairy foods is a key healthy eating strategy.” (pg 133)

“The source of protein may make a difference [in cancer development]. The International Agency for Research on Cancer, part of the World Health Organization, has concluded that processed meat is ‘carcinogenic to humans,’ while red meat is ‘probably carcinogenic.’” (pg 137)

“Country-to-country surveys of protein consumption and heart disease hint that the more plant protein in the diet, the less heart disease, and the more animal protein, the more heart disease.” (pg 137)

“Get your protein from plants when possible.” (pg 146)

“The media routinely churned out articles with provocative headlines […] trumpeting the ‘power’ of soy to lower cholesterol, prevent heart disease, ease hot flashes and other menopause-related problems, preserve memory, and protect against breast, prostate, and other cancers. That work didn’t hold up.” (pg 142)

Criterion 1.1. How well is the claim supported by current evidence?

3 out of 4

This claim received a score of three, indicating it is moderately supported by the current evidence.

A point of clarity regarding this claim is the following: EDBH states that pure protein isolated from either plants or animals is not likely to make a difference in health; rather, it is the “package” in which protein is delivered to the body that makes the difference in health outcomes.

The evidence found in the scientific literature generally aligns with this claim, although there is some murkiness still regarding these issues. In favor of this claim is a 2020 systematic review and meta-analysis of cohort studies that states higher plant protein intake is associated with lower risk of death from cardiovascular disease and death from any cause. A second systematic review indicates that a 3% increase in calories from plant protein is associated with a 5% reduction in risk of death from any cause. Since those reviews were published the results of another large cohort study were released with similar findings.

However, a 2019 meta-analysis of 36 randomized controlled trials showed that consumption of high quality sources of plant protein (such as legumes and nuts) led to favorable changes in cholesterol levels, but not much else in terms of cardiovascular disease risk factors. Further, it seems there was no meaningful difference in red meat and other types of meat like chicken or fish. Other systematic reviews and meta-analyses conclude that there is little difference in cancer, cardiovascular outcomes, and cardiovascular disease risk factors when red meat intake varies. However, a recent randomized controlled trial suggested the opposite: plant-based foods significantly improve cardiovascular risk factors compared to animal products. However, these studies did not focus specifically on protein intake but rather replacing animal protein with plant-based alternatives.

EDBH raises some concerns around soy protein. The skepticism of soy protein appears to be rooted in 2 particular studies: a 1998 trial that demonstrated women with breast cancer had increased proliferation when taking soy supplements; and a cohort study suggesting that those that ate tofu frequently were more likely to suffer mental decline. However, the trial that showed a link between soy and breast cancer may be an outlier as several reviews and meta-analyses since then have suggested the opposite: that soy intake confers a protective effect against breast cancer. When it comes to the link between soy and cognitive decline, that too appears to stand outside of most other evidence on the topic. Two meta-analyses – one published before EDBH and one published after – conclude that soy may improve cognitive function in adults.

Criterion 1.2. Are the references cited in the book to support the claim convincing?

4 out of 4

This item received a score of four, indicating it offers evidence that is both intrinsically convincing and predominantly supports the author’s claim.

As with the other claims made in the book, EDBH cites a variety of studies published in reputable, peer-reviewed journals that provide justifiable evidence for the statements that are made.

Criterion 1.3. How well does the strength of the claim line up with the strength of the evidence?

3 out of 4

This claim received a score of three, indicating moderate to good support from the scientific evidence.

In this case, the plant protein’s and “white” meat protein’s superiority over proteins from red and processed meats seems broadly true, but we found some conflicting evidence. Moreover, the “dark side” of soy, as it’s described in the text, seems to be mostly based on two individual studies that do not appear to represent the larger body of evidence that is currently available, or even that was available at the time of publication.

Overall (average) score for claim 3

3.3 out of 4

Overall (average) score for scientific accuracy

3.8 out of 4

Reference 1

Reference

Chapter 4, reference 20.  Schwarzfuchs, D., Golan, R., & Shai, I. (2012). Four-Year Follow-up after Two-Year Dietary Interventions. New England Journal of Medicine, 367(14), 1373–1374.

Associated quote(s) and page number(s)

Pages 56-57: [After discussion of a dietary trial known as DIRECT (Dietary Intervention Randomized Controlled Trial) which randomized participants to a low-fat, low-carbohydrate, or Mediterranean diet for two years] “When the researchers checked in with the participants four years after the trial had stopped, those originally in the low-fat group had regained all the weight they had lost, while those in the Mediterranean-diet group had maintained their weight loss; the low-carbohydrate group was in between. Favorable metabolic changes had also persisted in the Mediterranean-diet group.”

Criterion 2.1. Does the reference support the claim?

4 out of 4

This reference received a score of 4 indicating that it offers strong support for the claim. Four years after the trial was completed, the followers of the Mediterranean diet had regained the least amount of weight. They also had the lowest total cholesterol and triglycerides of the three diets. However, the low-carb diet had the lowest LDL:HDL ratio after four years.

Reference 2

Reference

Chapter 4, reference 23.  Biswas, A., Oh, P. I., Faulkner, G. E., Bajaj, R. R., Silver, M. A., Mitchell, M. S., & Alter, D. A. (2015). Sedentary Time and Its Association With Risk for Disease Incidence, Mortality, and Hospitalization in Adults. Annals of Internal Medicine, 162(2), 123.

Associated quote(s) and page number(s)

Page 61: “A 2015 meta-analysis of forty-seven studies that included more than 800,000 participants showed that the longer people sat, the greater their risk of dying during the study period or developing cardiovascular disease, cancer, and type 2 diabetes.”

Criterion 2.1. Does the reference support the claim?

4 out of 4

This reference received a score of 4 indicating that it offers strong support for the claim.

Reference 3

Reference

Chapter 7, reference 5.  Preis, S. R., Stampfer, M. J., Spiegelman, D., Willett, W. C., & Rimm, E. B. (2010). Dietary protein and risk of ischemic heart disease in middle-aged men. The American Journal of Clinical Nutrition, 92(5), 1265–1272.

Associated quote(s) and page number(s)

Page 137: “In an analysis my colleagues and I did among more than 43,000 men, intake of total protein was minimally associated with heart disease risk, while intake of protein from meat was associated with higher risk.”

Criterion 2.1. Does the reference support the claim?

3 out of 4

This reference received a score of 3 indicating that it offers moderate support for the claim. However, there are some minor caveats, like the men were 40-75 years of age. Most importantly, when all 43,960 men were included in the analysis there was only a statistical trend that indicated higher intakes of animal protein were associated with higher disease risk, and vegetable protein was associated with lower risk, but this trend was nonsignificant. When the population was restricted to “healthy” participants (those with no history of hypertension, hypercholesterolemia, and diabetes at baseline) then the association between heart disease and animal protein became significant. This appears to be a slight omission of detail.

Reference 4

Reference

Chapter 8, reference 5.   Joshipura, K. J., Ascherio, A., Manson, J. E., Stampfer, M. J., Rimm, E. B., Speizer, F. E., … Willett, W. C. (1999). Fruit and vegetable intake in relation to risk of ischemic stroke. JAMA, 282(13), 1233–1239.

Associated quote(s) and page number(s)

Page 156: “Other reviews and meta-analyses have shown that eating about thirty servings of fruit or vegetables a week (or just under five a day) was associated with a 30 percent lower risk of the most common type of stroke (ischemic stroke), the kind caused by a blood clot blocking an artery in, or to, the brain.”

Criterion 2.1. Does the reference support the claim?

4 out of 4

The text considers only two very large cohort trial, so referring to it as a review or meta-analysis is a bit of a stretch, nevertheless the cited text does conclude that a roughly 30 percent decrease in risk of ischemic stroke was found in groups that consumed about 5 servings of fruit and vegetables per day.

Reference 5

Reference

Chapter 8, reference 8.  Wu, J., Cho, E., Willett, W. C., Sastry, S. M., & Schaumberg, D. A. (2015). Intakes of Lutein, Zeaxanthin, and Other Carotenoids and Age-Related Macular Degeneration During 2 Decades of Prospective Follow-up. JAMA Ophthalmology, 133(12), 1415–1424.

Associated quote(s) and page number(s)

Page 157: “Dark leafy green vegetables contain two pigments, lutein and zeaxanthin, that accumulate in the eye. These two, along with phytochemicals called carotenoids, can snuff out free radicals before they can harm the eye’s sensitive tissues.”

Criterion 2.1. Does the reference support the claim?

3 out of 4

This reference received a score of 3 indicating it offers moderate support for the claim. The cited text is a study that indicates those that consume lutein, zeaxanthin, and other carotenoids have a reduced risk of age-related macular degeneration, which is a disease of the eye. The speculated mechanism by which carotenoids might affect age related macular degeneration is by accumulating in the eye and protecting it from oxidative damage and free radicals; however, this mechanism is not really examined in this study. Nevertheless, this study is good evidence that carotenoids play some role in protecting eye tissue.

Reference 6

Reference

Chapter 11, reference 10.  Zhang, S. M., Willett, W. C., Selhub, J., Hunter, D. J., Giovannucci, E. L., Holmes, M. D., … Hankinson, S. E. (2003). Plasma folate, vitamin B6, vitamin B12, homocysteine, and risk of breast cancer. Journal of the National Cancer Institute, 95(5), 373–380.

Associated quote(s) and page number(s)

Page 212: “One of the interesting findings we have seen in the Nurses’ Health Study—and that other researchers have seen in other populations—is that folic acid may temper the increase in breast cancer seen on women who average more than one alcoholic beverage per day.”

Criterion 2.1. Does the reference support the claim?

4 out of 4

This reference received a score of 4 indicating that it offers strong support for the claim. The cited text is from the Nurses’ Health Study that demonstrates that in women who were consuming at least 1 alcoholic drink per day, folate intake significantly reduced their risk of breast cancer.

Reference 7

Reference

Chapter 11, reference 11. Nan, H., Lee, J. E., Rimm, E. B., Fuchs, C. S., Giovannucci, E. L., & Cho, E. (2013). Prospective study of alcohol consumption and the risk of colorectal cancer before and after folic acid fortification in the United States. Annals of Epidemiology, 23(9), 558–563.

Associated quote(s) and page number(s)

Page 212: “The same is true of colon cancer, another disease that is more common among alcohol drinkers than nondrinkers. People who drink alcohol and get 600 micrograms or more of folic acid each day aren’t at increased risk, however.”

Criterion 2.1. Does the reference support the claim?

4 out of 4

This reference received a score of 4 indicating that it offers strong support for the claim. In this referenced study, alcohol consumption was associated with a greater risk of colon cancer, but for those consuming folic acid supplements or foods fortified with folic acid, drinkers appeared to not be at an increased risk of developing colon cancer.

Reference 8

Reference

Chapter 11, reference 41.  Sesso, H. D., Christen, W. G., Bubes, V., Smith, J. P., MacFadyen, J., Schvartz, M., … Gaziano, J. M. (2012). Multivitamins in the prevention of cardiovascular disease in men: the Physicians’ Health Study II randomized controlled trial. JAMA, 308(17), 1751–1760.

Associated quote(s) and page number(s)

Page 236: “The multivitamin-multimineral supplement didn’t appear to help prevent cardiovascular disease or protect memory or thinking skills.”

Criterion 2.1. Does the reference support the claim?

4 out of 4

This reference received a score of 4 indicating that it offers strong support for the claim. The cited text does provide high quality evidence in the form of the Physicians’ Health Study II, a randomized, double-blind, placebo-controlled trial. In this case the median follow-up period was 11.2 years, and it shows no cardiovascular benefit from a daily multivitamin-multimineral supplement. What was not referenced was the last part of the sentence that referenced cognitive ability, but those results also support the above claim.

Reference 9

Reference

Chapter 13, reference 6. Estruch, R., Ros, E., Salas-Salvadó, J., Covas, M.-I., Corella, D., Arós, F., … PREDIMED Study Investigators. (2013). Primary Prevention of Cardiovascular Disease with a Mediterranean Diet. New England Journal of Medicine, 368(14), 1279–1290.

Associated quote(s) and page number(s)

Page 255: “More recently, our colleague in Spain showed in a randomized controlled trial that a Mediterranean diet with added nuts or olive oil reduced cardiovascular disease risk by 30 percent compared to a low-fat diet.”

Criterion 2.1. Does the reference support the claim?

4 out of 4

This reference received a score of 4 indicating that it offers strong support for the claim. The study cited was a randomized trial with a median follow-up of 4.8 years that showed those on Mediterranean diets with extra nuts or olive oil had significantly less cardiovascular events than the low-fat diet group.

Reference 10

Reference

Chapter 13, reference 8. Anand, S. S., Hawkes, C., de Souza, R. J., Mente, A., Dehghan, M., Nugent, R., … Popkin, B. M. (2015). Food Consumption and its Impact on Cardiovascular Disease: Importance of Solutions Focused on the Globalized Food System: A Report From the Workshop Convened by the World Heart Federation. Journal of the American College of Cardiology, 66(14), 1590–1614.

Associated quote(s) and page number(s)

Page 256: “Fortunately, evidence from different types of studies done in many countries shows that the components of a Mediterranean-type diet offer major benefits even for people living modern ‘Western’ lifestyles.”

Criterion 2.1. Does the reference support the claim?

4 out of 4

This reference received a score of 4 indicating that it offers strong support for the claim. The report goes into detail regarding several macronutrients and foods and their impact on cardiovascular risk factors. Although many of the discussed foods in the cited report are not necessarily a part of the Mediterranean diet.

Overall (average) score for reference accuracy

3.8 out of 4

Summary of the health-related intervention promoted in the book

The health advice provided in the text is helpfully bullet pointed early-on and each chapter is devoted to a point. Here are those points:

• Eat plenty of vegetables and fruits, but limit fruit juices and corn, and hold the potatoes.
• Eat more good fats (these mostly come from plants) and fewer bad fats (these mostly come from meat and dairy foods).
• Eat more whole-grain carbohydrates and fewer refined-grain carbohydrates
• Choose healthy sources of protein, limit your consumption of red meat, and don’t eat processed meat.
• Drink more water. Coffee and tea are okay; sugar-sweetened soda and other beverages aren’t.
• Drink alcohol in moderation, if at all.
• Take a multivitamin for insurance, just in case you aren’t getting the vitamins and minerals you need from the foods you eat. Make sure it delivers at least 1,000 international units of vitamin D.

Condition targeted by the book, if applicable

General health, although the text focuses mostly on chronic diseases such as obesity, cardiovascular disease, and cancer

Apparent target audience of the book

There is no explicit audience for this book, but it appears to be a general audience.

Criterion 3.1. Is the intervention likely to improve the target condition?

4 out of 4

The intervention received a score of 4, indicating that following the dietary intervention is likely to  improve the conditions discussed in the book.

If you look at some specific conditions that are mentioned in the book like cardiovascular disease and cancers, the evidence is very strong that the dietary advice presented will mitigate the risk of those diseases and the book has accurately reflected the magnitude that the dietary changes are likely to affect outcomes.

Criterion 3.2. Is the intervention likely to improve general health in the target audience?

4 out of 4

The intervention received a score of 4, indicating that it is likely to greatly improve general health. This determination would depend on what the diet and lifestyle is of an individual prior to following this advice, but if one assumes a standard American diet with excess calories consisting of sugary foods/beverages, fried foods, refined grains, processed meats, and the two most consumed vegetables being potatoes (from french fries) and tomatoes (from pizza sauce), and little to no physical activity, then following this dietary advice would likely be a great improvement.

Criterion 3.3. Does the diet portion of the intervention promote an adequate nutrient intake for general health in the target audience?

4 out of 4

The diet received a score of 4, indicating the diet is likely substantially more than nutritionally adequate. The guidelines described in the text and the recipes provided near the end of the book would likely provide adequate nutrient intake for general health, in addition to plenty of bioactive compounds that have no formal intake recommendations. But the addition of a multivitamin to the diet effectively ensures a more-than-adequate intake of vitamins and minerals.

Overall (average) score for healthfulness

4 out of 4