Beyond Apples

How to keep the doctor away.

Are We Getting Nutrition All Wrong? (Part 2)

Am I getting nutrition all wrong, again?

This past weekend was spent in the “mecca” of wellness and prevention — Southern California. As I strolled through a Santa Monica farmer’s market surveying farm fresh foods, learning about organic farming, and yes, trying raw (unpasteurized) milk, I could not help wondering if yet again I was getting nutrition all wrong (see here). The visit was all the more illuminating because it followed a recent reading of “In Defense of Food” by Michael Pollan*, which challenged the way I think about food and eating. In this blog post I summarize the key points of the book and reflect on the lessons learned.

Synopsis

So what kind of diet does Michael Pollan espouse in his book? Low-fat? Low-carb? Low-calorie? None of these, actually. In fact, “In Defense of Food” rejects the notion that food can be understood by its constituent parts. “Food is more than the sum of its parts.” Thus thinking about food in reductionist terms – grams of fat, protein, and carbohydrates — is overly simplistic and plain wrong.

Find a Therapist

Search for a mental health professional near you.

Instead Mr. Pollan makes the case that we need to get back to thinking about food not nutrients, to eating real food not artificial products. His recommendations on a healthful diet are summarized in three simple sentences: “Eat food. Not too much. Mostly plants.”

While the second two assertions are self-evident, the first deserves some explanation. Eat food? What else do we eat, if not food? “In Defense of Food” argues that much of we eat today is not really food. Rather the Western diet is replete with “food-like” substances. As an example, Michael Pollan cites Wonder Bread. While at first glance Wonder Bread appears to be food (I mean, isn’t it just bread?), it’s really a commercial product. In fact, typing “wonder bread ingredients” into Google brings up “Wonder Bread History — Invention of Wonder Bread.” Here is a list of the ingredients in Classic Wonder Bread**:

Enriched Wheat Flour [Flour, Barley Malt, Ferrous Sulfate (Iron) B Vitamins (Niacin, Thiamine Mononitrate {B1}Riboflavin {B2}Folic Acid)Water, High Fructose Corn Syrup or Sugar, Yeast. contains 2% or less of Calcium Sulfate (Ingredients in Excess of Amount Present in Regular Enriched White Bread) Wheat Gluten, Soybean Oil, Salt, Dough Conditioners (May contain Mono and Diglycerides, Sodium Stearoyl Lactylate, Dicalcium Phosphate, Datem, Sorbic Acid, and/or Calcium Dioxide) Vinegar, Soy Flour, Tricalcium Phosphate (Ingredients in Excess of Amount Present in Regular Enriched White Bread)Yeast Nutrients (May Contain: Ammonium Phosphate, Monocalcium Phosphate, Calcium Carbonate, Ammonium Sulfate, Ammonium Chloride, and/or Diammonium Phosphate)Whey, Cornstarch, Wheat Starch, Enzymes, Calcium Propionate, to Retain Freshness) Soy Lecithin. Kosher Information – Contains Less Than 1.6 % of Whey (A Milk Derivative).

Some of these ingredients are no doubt essential to making bread. But one has to “wonder” about the need for high fructose corn syrup, dough conditioners, and cornstarch. Thus when we stop to think about it, the recommendation to “eat food” is not as straightforward as it would seem. The food industry has created an array of products that distort the natural composition of foods. There is a variety of reasons for this (cost, storability, fortification) but the end result is that our “foods” often contain a host of ingredients that are unwanted and have undesirable or unknown effects on our health.

The broader concept is that we need to pay attention not so much to what’s in our food but where our food comes from. “You are what you eat eats.” Not all pieces of steak are created equal. Some cattle are fed almost exclusively soy, raised in cell-like quarters, and given periodic shots of hormones and antibiotics. Others are grass fed, free roaming, and organic. The concept applies to vegetables too. Vegetables from your backyard are different from those in your local Whole Foods’ organic aisle, which are different from those in the local megachain grocery store. And it extends to food products such as yogurts and orange juice.

Comment

My major criticism of “In Defense of Food” is that it is light on data. Most of its assertions are presented without supporting evidence. Those data that are provided are often interesting but seldom definitive. For example, Mr. Pollan notes that over the past two decades as the percentage of gross domestic product (GDP) spent on food has declined the proportion spent on health care has skyrocketed. (The implication is that as we have gone from high quality, expensive farm fresh foods to mass produced, cheap food products we have gotten sicker.)

But where the book lacks in data it makes up in concepts. So much of what we read today in nutrition are variations on the same theme. While a low-fat diet and low-carb diet are on one level radically different, they both follow the prevailing ideology of “nutritionism” — the notion that the effect of food on health can be understood by studying its nutritional properties. What “In Defense of Food” presents is a different point of view.

It’s easy to forget that just a generation or two ago people did not think in terms of protein, carbs, and fat. When we eat a steak or a can of beans, we often think about “getting our proteins in;” when we deny ourselves ice cream we are shying away from carbs and fats. But many of our parents and certainly our grandparents grew up in a world in which foods were just foods. It’s equally easy to forget that the value of thinking of food through the lens of nutrition is just a hypothesis. (Clearly from a macro view — in terms of prevalence of diabetes and obesity – our health has only worsened since this paradigm shift.) Simply being reminded that nutrition and food aren’t necessarily the same thing was one of my major take aways from the book.

As many observers have noted, the vast majority of clinical trials of one diet versus another have been null or negative trials. That is, most studies that try to increase carbohydrate consumption or decrease fat consumption do not show any differences in health outcomes. One intriguing explanation for this is that all these trials are just variations on the same theme. Thus the lack of positive nutrition trials indirectly lends credence to idea that nutritionism is misguided and ultimately defeatist. The problem is with the entire “Western diet” not simply a component or two of it.

To me the most convincing evidence is that we are getting nutrition all wrong is that today diseases that were once rare or nonexistent in indigenous populations have become commonplace. These “diseases of civilization” not only include diabetes and obesity but also appendicitis, cancers (including of the  breast and colon), and arguably coronary heart disease. We know this from reports of Western-trained physicians working in indigenous populations from Africa to Asia at the turn of the last century and more recently from population studies of Asian immigrants to the United States.

The simple fact is that something about our current way of life is dangerously unhealthy. While much has changed about us in the past 200 years (e.g., exposure to pollution, stress, urbanization), it seems likely that our changing diet is the most likely culprit. While many of us have focused on the changing nutrition in our diet to explain this trend, it stands to reason that we should at least consider the possibility that the changing nature of our diet is at least part of the problem.

Copyright Shantanu Nundy, M.D.

If you enjoyed this post, please visit Dr. Nundy's web site BeyondApples or read his book, Stay Healthy At Every Age.

To read Michael Pollan in his own words read ”Unhappy Meals”:http://www.nytimes.com/2007/01/28/magazine/28nutritionism.t.html?pagewanted=all

* “In Defense of Food — An Eater’s Manifesto” by Michael Pollan, April 2009, Penguin Press

** from www.zeer.com; Wonder Bread does not publish the ingredients of its products on its website www.wonderbread.com

Shantanu Nundy is a staff physician at the University of Chicago Medical Center. He is the author of Stay Healthy at Every Age.

more...

Subscribe to Beyond Apples

Current Issue

Dreams of Glory

Daydreaming: How the best ideas emerge from the ether.