How To Gain Weight (Healthily!)

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What Do You Have To Gain?

We have previously promised a three-part series about changing one’s weight:

  1. Losing weight (specifically, losing fat)
  2. Gaining weight (specifically, gaining muscle)
  3. Gaining weight (specifically, gaining fat)

There will be, however, no need for a “losing muscle” article, because (even though sometimes a person might have some reason to want to do this), it’s really just a case of “those things we said for gaining muscle? Don’t do those and the muscle will atrophy naturally”.

Here’s our first article: How To Lose Weight (Healthily!)

While some people will want to lose fat, please do be aware that the association between weight loss and good health is not nearly so strong as the weight loss industry would have you believe:

Shedding Some Obesity Myths

And, while BMI is not a useful measure of health in general, it’s worth noting that over the age of 65, a BMI of 27 (which is in the high end of “overweight”, without being obese) is associated with the lowest all-cause mortality:

BMI and all-cause mortality in older adults: a meta-analysis

Here was our second article: How To Build Muscle (Healthily!)

And now, it’s time for the last part, which yes, is also something that some people want/need to do (healthily!), and want/need help with that.

How to gain fat, healthily

Fat gets a bad press, but when it comes to health, we would die without it.

Even in the case of having excess fat, the fat itself is not generally the problem, so much as comorbid metabolic issues that are often caused by the same things as the excess fat.

So, how to gain fat healthily?

  • Obvious but potentially dangerously misleading answer: “in moderation”
  • More useful answer: “carefully”

Because, you can “in moderation” put on less than one pound per week for a few years and be in very bad health by the end of it. So how does this “carefully” work any differently to “in moderation”?

The key is in how we store the fat

Not merely where we store it (though that’ll follow from the “how”), but specifically: how we store it.

  • When we consume energy from food in excess of our immediate survival needs, our body stores what it can. This is good!
  • When our body is receiving energy from food faster than it can physically process it to store it healthily, it will start shoving it wherever it can instead. This is bad!

This is the physiological equivalent of the difference between tidying a room carefully, and cramming everything into one cupboard in 30 seconds just to get it out of sight.

So, you do need to consume calories yes, but you need to consume them in a way your body can take its time about storing them.

We’ve written before about the science of this, so we’ll share some links, but first, here are the practical tips:

  • Do not drink your calories. Drinking calories tends to be the equivalent of injecting sugars directly into your veins, in terms of how quickly it gets received.
    • See also: How To Unfatty A Fatty Liver ← this is highly relevant, because the same process that results in unhealthy weight gain, results in liver disease, by the same mechanism (the liver gets overwhelmed).
  • Eat your greens. No, they won’t provide many calories, but they are critical to your body not being overwhelmed by the arrival of sugars.
    • See also: 10 Ways To Balance Blood Sugars ← the other 9 things are also helpful for not putting on fat unhealthily, so using these alongside a calorie-dense diet can result in healthy fat gain as needed
  • Get more of your calories from fats than carbs. Fats will not overwhelm your body’s glycemic response in the same way that carbs will.
  • Consider going low-carb, but even if you choose not to, go for carbs with a low glycemic index instead of a high glycemic index.
  • Need healthy fats in a snack? Enjoy nuts (unless you have an allergy); they will be your best friend in this regard. As an example, a mere 1oz portion of cashew nuts has 157 calories.
  • Need healthy fats for cooking? Enjoy olive oil, as it has one of the healthiest lipids profiles available, and is a great way to increase the calorific content of many meals.

Lastly…

Be patient, enjoy your food, and stick as best you can to the above considerations. All strength to you.

Take care!

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  • 5 Ways To Avoid Hearing Loss

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    Hear Ye, Hear Ye

    Hearing loss is often associated with getting older—but it can strike at any age. In the US, for example…

    • Around 13% of adults have hearing difficulties
    • Nearly 27% of those over 65 have hearing difficulties

    Complete or near-complete hearing loss is less common. From the same source…

    • A little under 2% of adults in general had a total or near-total inability to hear
    • A little over 4% of those over 65 had a total or near-total inability to hear

    Source: CDC | Hearing Difficulties Among Adults: United States, 2019

    So, what to do if we want to keep our hearing as it is?

    Avoid loud environments

    An obvious one, but it bears stating for the sake of being methodical. Loud environments damage our ears, but how loud is too loud?

    You can check how loud an environment is by using a free smartphone app, such as:

    Decibel Pro: dB Sound Level Meter (iOS / Android)

    An 82 dB environment is considered safe for 16 hours. That’s the equivalent of, for example moderate traffic.

    Every 3 dB added to that halves the safe exposure time, for example:

    • An 85 dB environment is considered safe for 8 hours. That’s the equivalent of heavier traffic, or a vacuum cleaner.
    • A 94 dB environment is considered safe for 1 hour. That might be a chainsaw, a motorcycle, or a large sporting event.

    Many nightclubs or concert venues often have environments of 110 dB and more. So the safe exposure time would be under two minutes.

    Source: NIOSH | Noise and Hearing Loss

    With differences like that per 3 dB increase, then you may want to wear hearing protection if you’re going to be in a noisy environment.

    Discreet options include things like these -20 dB silicone ear plugs that live in a little case on one’s keyring.

    Stop sticking things in your ears

    It’s said “nothing smaller than your elbow should go in your ear canal”. We’ve written about this before:

    What’s Good (And What’s Not) Against Earwax

    Look after the rest of your health

    Our ears are not islands unaffected by the rest of our health, and indeed, they’re larger and more complex organs than we think about most of the time, since we only tend to think about the (least important!) external part.

    Common causes of hearing loss that aren’t the percussive injuries we discussed above include:

    • Diabetes
    • High blood pressure
    • Smoking
    • Infections
    • Medications

    Lest that last one sound a little vague, it’s because there are hundreds of medications that have hearing loss as a potential side-effect. Here’s a list so you can check if you’re taking any of them:

    List of Ototoxic Medications That May Cause Tinnitus or Hearing Loss

    Get your hearing tested regularly.

    There are online tests, but we recommend an in-person test at a local clinic, as it won’t be subject to the limitations and quirks of the device(s) you’re using. Pretty much anywhere that sells hearing aids will probably offer you a free test, so take advantage of it!

    And, more generally, if you suddenly notice you lost some or all of your hearing in one or more ears, then get thee to a doctor, and quickly.

    Treat it as an emergency, because there are many things that can be treated if and only if they are caught early, before the damage becomes permanent.

    Use it or lose it

    This one’s important. As we get older, it’s easy to become more reclusive, but the whole “neurons that fire together, wire together” neuroplasticity thing goes for our hearing too.

    Our brain is, effectively, our innermost hearing organ, insofar as it processes the information it receives about sounds that were heard.

    There are neurological hearing problems that can show up without external physical hearing damage (auditory processing disorders being high on the list), but usually these things are comorbid with each other.

    So if we want to maintain our ability to process the sounds our ears detect, then we need to practice that ability.

    Important implication:

    That means that if you might benefit from a hearing aid, you should get it now, not later.

    It’s counterintuitive, we know, but because of the neurological consequences, hearing aids help people retain their hearing, whereas soldiering on without can hasten hearing loss.

    On the topic of hearing difficulty comorbidities…

    Tinnitus (ringing in the ears) is, paradoxically, associated with both hearing loss, and with hyperacusis (hearing supersensitivity, which sounds like a superpower, but can be quite a problem too).

    Learn more about managing that, here:

    Tinnitus: Quieting The Unwanted Orchestra In Your Ears

    Take care!

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  • Ham Substitute in Bean Soup

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    It’s Q&A Day at 10almonds!

    Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!

    In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!

    As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!

    So, no question/request too big or small

    I am interested in what I can substitute for ham in bean soup?

    Well, that depends on what the ham was like! You can certainly buy ready-made vegan lardons (i.e. small bacon/ham bits, often in tiny cubes or similar) in any reasonably-sized supermarket. Being processed, they’re not amazing for the health, but are still an improvement on pork.

    Alternatively, you can make your own seitan! Again, seitan is really not a health food, but again, it’s still relatively less bad than pork (unless you are allergic to gluten, in which case, definitely skip this one).

    Alternatively alternatively, in a soup that already contains beans (so the protein element is already covered), you could just skip the ham as an added ingredient, and instead bring the extra flavor by means of a little salt, a little yeast extract (if you don’t like yeast extract, don’t worry, it won’t taste like it if you just use a teaspoon in a big pot, or half a teaspoon in a smaller pot), and a little smoked paprika. If you want to go healthier, you can swap out the salt for MSG, which enhances flavor in a similar fashion while containing less sodium.

    Wondering about the health aspects of MSG? Check out our main feature on this, from last month:

    What’s the deal with MSG?

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  • Hormones & Health, Beyond The Obvious

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    Wholesome Health

    This is Dr. Sara Gottfried, who some decades ago got her MD from Harvard and specialized as an OB/GYN at MIT. She’s since then spent the more recent part of her career educating people (mostly: women) about hormonal health, precision, functional, & integrative medicine, and the importance of lifestyle medicine in general.

    What does she want us to know?

    Beyond “bikini zone health”

    Dr. Gottfried urges us to pay attention to our whole health, in context.

    “Women’s health” is often thought of as what lies beneath a bikini, and if it’s not in those places, then we can basically treat a woman like a man.

    And that’s often not actually true—because hormones affect every living cell in our body, and as a result, while prepubescent girls and postmenopausal women (specifically, those who are not on HRT) may share a few more similarities with boys and men of similar respective ages, for most people at most ages, men and women are by default quite different metabolically—which is what counts for a lot of diseases! And note, that difference is not just “faster” or “slower””, but is often very different in manner also.

    That’s why, even in cases where incidence of disease is approximately similar in men and women when other factors are controlled for (age, lifestyle, medical history, etc), the disease course and response to treatment may vary considerable. For a strong example of this, see for example:

    • The well-known: Heart Attack: His & Hers ← most people know these differences exist, but it’s always good to brush up on what they actually are
    • The less-known: Statins: His & Hers ← most people don’t know these differences exist, and it pays to know, especially if you are a woman or care about one

    Nor are brains exempt from his…

    The female brain (kinda)

    While the notion of an anatomically different brain for men and women has long since been thrown out as unscientific phrenology, and the idea of a genetically different brain is… Well, it’s an unreliable indicator, because technically the cells will have DNA and that DNA will usually (but not always; there are other options) have XX or XY chromosomes, which will usually (but again, not always) match apparent sex (in about 1/2000 cases there’s a mismatch, which is more common than, say, red hair; sometimes people find out about a chromosomal mismatch only later in life when getting a DNA test for some unrelated reason), and in any case, even for most of us, the chromosomal differences don’t count for much outside of antenatal development (telling the default genital materials which genitals to develop into, though this too can get diverted, per many intersex possibilities, which is also a lot more common than people think) or chromosome-specific conditions like colorblindness…

    The notion of a hormonally different brain is, in contrast to all of the above, a reliable and easily verifiable thing.

    See for example:

    Alzheimer’s Sex Differences May Not Be What They Appear

    Dr. Gottfried urges us to take the above seriously!

    Because, if women get Alzheimer’s much more commonly than men, and the disease progresses much more quickly in women than men, but that’s based on postmenopausal women not on HRT, then that’s saying “Women, without women’s usual hormones, don’t do so well as men with men’s usual hormones”.

    She does, by the way, advocate for bioidentical HRT for menopausal women, unless contraindicated for some important reason that your doctor/endocrinologist knows about. See also:

    Menopausal HRT: A Tale Of Two Approaches (Bioidentical vs Animal)

    The other very relevant hormone

    …that Dr. Gottfried wants us to pay attention to is insulin.

    Or rather, its scrubbing enzyme, the prosaically-named “insulin-degrading enzyme”, but it doesn’t only scrub insulin. It also scrubs amyloid beta—yes, the same that produces the amyloid beta plaques in the brain associated with Alzheimer’s. And, there’s only so much insulin-degrading enzyme to go around, and if it’s all busy breaking down excess insulin, there’s not enough left to do the other job too, and thus can’t break down amyloid beta.

    In other words: to fight neurodegeneration, keep your blood sugars healthy.

    This may actually work by multiple mechanisms besides the amyloid hypothesis, by the way:

    The Surprising Link Between Type 2 Diabetes & Alzheimer’s

    Want more from Dr. Gottfried?

    You might like this interview with Dr. Gottfried by Dr. Benson at the IMCJ:

    Integrative Medicine: A Clinician’s Journal | Conversations with Sara Gottfried, MD

    …in which she discusses some of the things we talked about today, and also about her shift from a pharmaceutical-heavy approach to a predominantly lifestyle medicine approach.

    Enjoy!

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  • Why the WHO has recommended switching to a healthier salt alternative

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    This week the World Health Organization (WHO) released new guidelines recommending people switch the regular salt they use at home for substitutes containing less sodium.

    But what exactly are these salt alternatives? And why is the WHO recommending this? Let’s take a look.

    goodbishop/Shutterstock

    A new solution to an old problem

    Advice to eat less salt (sodium chloride) is not new. It has been part of international and Australian guidelines for decades. This is because evidence clearly shows the sodium in salt can harm our health when we eat too much of it.

    Excess sodium increases the risk of high blood pressure, which affects millions of Australians (around one in three adults). High blood pressure (hypertension) in turn increases the risk of heart disease, stroke and kidney disease, among other conditions.

    The WHO estimates 1.9 million deaths globally each year can be attributed to eating too much salt.

    The WHO recommends consuming no more than 2g of sodium daily. However people eat on average more than double this, around 4.3g a day.

    In 2013, WHO member states committed to reducing population sodium intake by 30% by 2025. But cutting salt intake has proved very hard. Most countries, including Australia, will not meet the WHO’s goal for reducing sodium intake by 2025. The WHO has since set the same target for 2030.

    The difficulty is that eating less salt means accepting a less salty taste. It also requires changes to established ways of preparing food. This has proved too much to ask of people making food at home, and too much for the food industry.

    A salt shaker spilling onto a table.
    There’s been little progress on efforts to cut sodium intake. snezhana k/Shutterstock

    Enter potassium-enriched salt

    The main lower-sodium salt substitute is called potassium-enriched salt. This is salt where some of the sodium chloride has been replaced with potassium chloride.

    Potassium is an essential mineral, playing a key role in all the body’s functions. The high potassium content of fresh fruit and vegetables is one of the main reasons they’re so good for you. While people are eating more sodium than they should, many don’t get enough potassium.

    The WHO recommends a daily potassium intake of 3.5g, but on the whole, people in most countries consume significantly less than this.

    Potassium-enriched salt benefits our health by cutting the amount of sodium we consume, and increasing the amount of potassium in our diets. Both help to lower blood pressure.

    Switching regular salt for potassium-enriched salt has been shown to reduce the risk of heart disease, stroke and premature death in large trials around the world.

    Modelling studies have projected that population-wide switches to potassium-enriched salt use would prevent hundreds of thousands of deaths from cardiovascular disease (such as heart attack and stroke) each year in China and India alone.

    The key advantage of switching rather than cutting salt intake is that potassium-enriched salt can be used as a direct one-for-one swap for regular salt. It looks the same, works for seasoning and in recipes, and most people don’t notice any important difference in taste.

    In the largest trial of potassium-enriched salt to date, more than 90% of people were still using the product after five years.

    A female nurse taking a senior man's blood pressure.
    Excess sodium intake increases the risk of high blood pressure, which can cause a range of health problems. PeopleImages.com – Yuri A/Shutterstock

    Making the switch: some challenges

    If fully implemented, this could be one of the most consequential pieces of advice the WHO has ever provided.

    Millions of strokes and heart attacks could be prevented worldwide each year with a simple switch to the way we prepare foods. But there are some obstacles to overcome before we get to this point.

    First, it will be important to balance the benefits and the risks. For example, people with advanced kidney disease don’t handle potassium well and so these products are not suitable for them. This is only a small proportion of the population, but we need to ensure potassium-enriched salt products are labelled with appropriate warnings.

    A key challenge will be making potassium-enriched salt more affordable and accessible. Potassium chloride is more expensive to produce than sodium chloride, and at present, potassium-enriched salt is mostly sold as a niche health product at a premium price.

    If you’re looking for it, salt substitutes may also be called low-sodium salt, potassium salt, heart salt, mineral salt, or sodium-reduced salt.

    A review published in 2021 found low sodium salts were marketed in only 47 countries, mostly high-income ones. Prices ranged from the same as regular salt to almost 15 times higher.

    An expanded supply chain that produces much more food-grade potassium chloride will be needed to enable wider availability of the product. And we’ll need to see potassium-enriched salt on the shelves next to regular salt so it’s easy for people to find.

    In countries like Australia, about 80% of the salt we eat comes from processed foods. The WHO guideline falls short by not explicitly prioritising a switch for the salt used in food manufacturing.

    Stakeholders working with government to encourage food industry uptake will be essential for maximising the health benefits.

    Xiaoyue (Luna) Xu, Scientia Lecturer, School of Population Health, UNSW Sydney and Bruce Neal, Executive Director, George Institute Australia, George Institute for Global Health

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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  • Children can be more vulnerable in the heat. Here’s how to protect them this summer

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    Extreme heat is increasingly common in Australia and around the world and besides making us uncomfortable, it can harm our health. For example, exposure to extreme heat can exacerbate existing medical conditions, or cause problems such as heat stroke.

    Due to a combination of physiology and behaviour, children are potentially more vulnerable to severe heat-related illness such as heat stroke or heat exhaustion.

    But these are not the only heat-related health issues children might experience on a very hot day. In a new study, we looked at emergency department (ED) visits and unplanned hospital admissions among children in New South Wales on heatwave days.

    We found a significant increase in children attending hospital compared to milder days – with a range of health issues.

    maxim ibragimov/Shutterstock

    Why are children more vulnerable in the heat?

    Sweating is the main way we lose heat from our bodies and cool down.

    Children have a greater skin surface area to body mass ratio, which can be an advantage for sweating – they can lose more heat through evaporation for a given body mass. But this also means children can lose fluids and electrolytes faster through sweating, theoretically making them more susceptible to dehydration.

    Meanwhile, younger children, particularly babies, can’t sweat as much as older children and adults. This means they can’t cool down as effectively.

    Children in general also tend to engage in more outdoor physical activity, which might see them more exposed to very hot temperatures.

    Further, children may be less in-tune to the signals their body is giving them that they’re overheating, such as excessive sweating or red skin. So they might not stop and cool down when they need to. Young children especially may not recognise the early signs of heat stress or be able to express discomfort.

    A boy drinking from a drink bottle, appears hot and bothered.
    Children may not easily be able to communicate that they’re hot and bothered. christinarosepix/Shutterstock

    Our study

    We wanted to examine children’s exposure to extreme heat stress and the associated risks to their health.

    We measured extreme heat as “heatwave days”, at least two consecutive days with a daily maximum temperature above the 95th percentile for the relevant area on a universal thermal climate index. This ranged from 27°C to 45°C depending on the area.

    We assessed health outcomes by looking at ED visits and unplanned hospital admissions among children aged 0–18 years from NSW between 2000 and 2020. This totalled around 8.2 million ED visits and 1.4 million hospital admissions.

    We found hospital admissions for heat-related illness were 104% more likely on heatwave days compared to non-heatwave days, and ED visits were 78% more likely. Heat-related illness includes a spectrum of disorders from minor conditions such as dehydration to life-threatening conditions such as heat stroke.

    But heat-related illness wasn’t the only condition that increased on heatwave days. There was also an increase in childhood infections, particularly infectious enteritis possibly related to food poisoning (up 6% for ED visits and 17% for hospital admissions), ear infections (up 30% for ED visits and 3% for hospital admissions), and skin and soft tissue infections (up 6% for ED visits and 4% for hospital admissions).

    A boy standing in front of a sprinkler.
    Kids can be more vulnerable in the heat because of their behaviour and physiology. K-FK/Shutterstock

    We know many infectious diseases are highly seasonal. Some, like the flu, peak in winter. But heat and humidity increase the risk of certain infections caused by bacterial, viral and fungal pathogens.

    For example, warmer weather and higher humidity can increase the survival of bacteria, such as Salmonella, on foods, which increases the risk of food poisoning.

    Hot weather can also increase the risk of ear infections. Children may be at greater risk during hot weather because they often swim or play at the beach or pool. Water can stay in the ear after swimming and a moist environment in the ear canal can cause growth of pathogens leading to ear infections.

    Which children are most vulnerable?

    During heatwaves, we found infants aged under one were at increased risk of ED visits and hospital admission for any reason compared to older children. This is not surprising, because babies can’t regulate their body temperature effectively and are reliant on their caregivers to keep them cool.

    Our study also found children from the most disadvantaged areas were more vulnerable to heat-related illness on heatwave days. Although we don’t know exactly why, we hypothesised families from poorer areas might have limited access to air-conditioning and could be more likely to live in hotter neighbourhoods.

    Keeping kids cool: tips for parents

    The highest levels of heat exposure on hot days for young children is usually when they’re taken outside in prams and strollers. To protect their children from direct sunlight, parents often instinctively cover their stroller with a cloth such as a muslin.

    However, a recent study from our group showed this actually increases temperatures inside a stroller to as much as 3–4˚C higher than outside.

    But if the cloth is wet with water, and a small fan is used to circulate the air close to the child, stroller temperatures can be 4–5˚C lower than outside. Wetting the cloth every 15–20 minutes (for example, with a spray bottle) maintains the cooling effect.

    When young children are not in a stroller, and for older children, there are a few things to consider to keep them cool and safe.

    Remember temperatures reported on weather forecasts are measured in the shade, and temperatures in the sun can be up to 15˚C higher. So sticking to the shade as much as possible is important.

    Exercise generates heat inside the body, so activities should be shortened, or rescheduled to cooler times of the day.

    Sunscreen and hats are important when outdoors, but neither are especially effective for keeping cool. Spraying water on the child’s skin – not just the face but arms, legs and even the torso if possible – can help. Wetting their hats is another idea.

    Proper hydration on hot days is also essential. Regular water breaks, including offering water before, during and after activity, is important. Offering foods with high water content such as watermelon and orange can help with hydration too.

    Wen-Qiang He, Research Fellow in Biostatistics and Epidemiology, Faculty of Medicine and Health, University of Sydney; James Smallcombe, Post-doctoral Research Associate, Faculty of Medicine and Health, University of Sydney; Natasha Nassar, Professor of Paediatric and Perinatal Epidemiology and Chair in Translational Childhood Medicine, University of Sydney, and Ollie Jay, Professor of Heat & Health; Director of Heat & Health Research Incubator; Director of Thermal Ergonomics Laboratory, University of Sydney

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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  • Tofu vs Seitan – Which is Healthier?

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    Our Verdict

    When comparing tofu to seitan, we picked the tofu.

    Why?

    This one is not close!

    In terms of macros, seitan does have about 2x the protein, but it also has 6x the carbs and 6x the sodium of tofu, as well as less fiber than tofu.. So we’ll call it a tie on macros. But…

    Seitan is also much more processed than tofu, as tofu has usually just been fermented and possibly pressed (depending on kind). Seitan, in contrast, is processed gluten that has been extracted from wheat and usually had lots of things happen to it on the way (depending on kind).

    About that protein… Tofu is a complete protein, meaning it has all of the essential amino acids. Seitain, meanwhile, is lacking in lysine.

    When it comes to vitamins and minerals, again tofu easily comes out on top; tofu has 5x the calcium, similar iron, more magnesium, 2x the phosphorous, 150% of the potassium, and contains several other nutrients that seitan doesn’t, such as folate and choline.

    So, easy winning for tofu across the board on micronutrients.

    Tofu is also rich in isoflavones, antioxidant phytonutrients, while seitan has no such benefits.

    So, another win for tofu.

    There are two reasons you might choose seitan:

    • prioritizing bulk protein above all other health considerations
    • you are allergic to soy and not allergic to gluten

    If neither of those things are the case, then tofu is the healthier choice!

    Want to learn more?

    You might like to read:

    Take care!

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