[Lapg] Real Food in The Age of Nutritionism

[Eric Werbalowsky]

...readers of Pollan's work are already familiar with the insight he
delivers, plus anyone interested in health vis a vis nutrition will be
pleased. This is a fairly long essay, pasted herein and with url -- i'd
guess 20 minutes reading time for public school/state college grads. For
those who enjoy dessert first, the last page of the article has a 9 point
exec. summary...

great points on pitfalls of scientific reductionism, relationship of
culture/cuisine, the politics of science, and how we already knew this

in perma-speak, this article spotlights key design elements and assumptions
in our modern food chain, along with the wisdom of holistic scientific
inquiry

ew

Unhappy Meals
By MICHAEL POLLAN
January 28, 2007
The New York Times

http://www.nytimes.com/2007/11/04/opinion/04pollan.html

Eat food. Not too much. Mostly plants.

That, more or less, is the short answer to the supposedly incredibly
complicated and confusing question of what we humans should eat in order to
be maximally healthy. I hate to give away the game right here at the
beginning of a long essay, and I confess that I'm tempted to complicate
matters in the interest of keeping things going for a few thousand more
words. I'll try to resist but will go ahead and add a couple more details to
flesh out the advice. Like: A little meat won't kill you, though it's better
approached as a side dish than as a main. And you're much better off eating
whole fresh foods than processed food products. That's what I mean by the
recommendation to eat "food." Once, food was all you could eat, but today
there are lots of other edible foodlike substances in the supermarket. These
novel products of food science often come in packages festooned with health
claims, which brings me to a related rule of thumb: if you're concerned
about your health, you should probably avoid food products that make health
claims. Why? Because a health claim on a food product is a good indication
that it's not really food, and food is what you want to eat.

Uh-oh. Things are suddenly sounding a little more complicated, aren't they?
Sorry. But that's how it goes as soon as you try to get to the bottom of the
whole vexing question of food and health. Before long, a dense cloud bank of
confusion moves in. Sooner or later, everything solid you thought you knew
about the links between diet and health gets blown away in the gust of the
latest study.

Last winter came the news that a low-fat diet, long believed to protect
against breast cancer, may do no such thing — this from the monumental,
federally financed Women's Health Initiative, which has also found no link
between a low-fat diet and rates of coronary disease. The year before we
learned that dietary fiber might not, as we had been confidently told, help
prevent colon cancer. Just last fall two prestigious studies on omega-3 fats
published at the same time presented us with strikingly different
conclusions. While the Institute of Medicine stated that "it is uncertain
how much these omega-3s contribute to improving health" (and they might do
the opposite if you get them from mercury-contaminated fish), a Harvard
study declared that simply by eating a couple of servings of fish each week
(or by downing enough fish oil), you could cut your risk of dying from a
heart attack by more than a third — a stunningly hopeful piece of news. It's
no wonder that omega-3 fatty acids are poised to become the oat bran of
2007, as food scientists micro-encapsulate fish oil and algae oil and blast
them into such formerly all-terrestrial foods as bread and tortillas, milk
and yogurt and cheese, all of which will soon, you can be sure, sprout fishy
new health claims. (Remember the rule?)

By now you're probably registering the cognitive dissonance of the
supermarket shopper or science-section reader, as well as some nostalgia for
the simplicity and solidity of the first few sentences of this essay. Which
I'm still prepared to defend against the shifting winds of nutritional
science and food-industry marketing. But before I do that, it might be
useful to figure out how we arrived at our present state of nutritional
confusion and anxiety.

The story of how the most basic questions about what to eat ever got so
complicated reveals a great deal about the institutional imperatives of the
food industry, nutritional science and — ahem — journalism, three parties
that stand to gain much from widespread confusion surrounding what is, after
all, the most elemental question an omnivore confronts. Humans deciding what
to eat without expert help — something they have been doing with notable
success since coming down out of the trees — is seriously unprofitable if
you're a food company, distinctly risky if you're a nutritionist and just
plain boring if you're a newspaper editor or journalist. (Or, for that
matter, an eater. Who wants to hear, yet again, "Eat more fruits and
vegetables"?) And so, like a large gray fog, a great Conspiracy of Confusion
has gathered around the simplest questions of nutrition — much to the
advantage of everybody involved. Except perhaps the ostensible beneficiary
of all this nutritional expertise and advice: us, and our health and
happiness as eaters.

FROM FOODS TO NUTRIENTS

It was in the 1980s that food began disappearing from the American
supermarket, gradually to be replaced by "nutrients," which are not the same
thing. Where once the familiar names of recognizable comestibles — things
like eggs or breakfast cereal or cookies — claimed pride of place on the
brightly colored packages crowding the aisles, now new terms like "fiber"
and "cholesterol" and "saturated fat" rose to large-type prominence. More
important than mere foods, the presence or absence of these invisible
substances was now generally believed to confer health benefits on their
eaters. Foods by comparison were coarse, old-fashioned and decidedly
unscientific things — who could say what was in them, really? But nutrients
— those chemical compounds and minerals in foods that nutritionists have
deemed important to health — gleamed with the promise of scientific
certainty; eat more of the right ones, fewer of the wrong, and you would
live longer and avoid chronic diseases.

Nutrients themselves had been around, as a concept, since the early 19th
century, when the English doctor and chemist William Prout identified what
came to be called the "macronutrients": protein, fat and carbohydrates. It
was thought that that was pretty much all there was going on in food, until
doctors noticed that an adequate supply of the big three did not necessarily
keep people nourished. At the end of the 19th century, British doctors were
puzzled by the fact that Chinese laborers in the Malay states were dying of
a disease called beriberi, which didn't seem to afflict Tamils or native
Malays. The mystery was solved when someone pointed out that the Chinese ate
"polished," or white, rice, while the others ate rice that hadn't been
mechanically milled. A few years later, Casimir Funk, a Polish chemist,
discovered the "essential nutrient" in rice husks that protected against
beriberi and called it a "vitamine," the first micronutrient. Vitamins
brought a kind of glamour to the science of nutrition, and though certain
sectors of the population began to eat by its expert lights, it really
wasn't until late in the 20th century that nutrients managed to push food
aside in the popular imagination of what it means to eat.

No single event marked the shift from eating food to eating nutrients,
though in retrospect a little-noticed political dust-up in Washington in
1977 seems to have helped propel American food culture down this dimly
lighted path. Responding to an alarming increase in chronic diseases linked
to diet — including heart disease, cancer and diabetes — a Senate Select
Committee on Nutrition, headed by George McGovern, held hearings on the
problem and prepared what by all rights should have been an uncontroversial
document called "Dietary Goals for the United States." The committee learned
that while rates of coronary heart disease had soared in America since World
War II, other cultures that consumed traditional diets based largely on
plants had strikingly low rates of chronic disease. Epidemiologists also had
observed that in America during the war years, when meat and dairy products
were strictly rationed, the rate of heart disease temporarily plummeted.

Naïvely putting two and two together, the committee drafted a
straightforward set of dietary guidelines calling on Americans to cut down
on red meat and dairy products. Within weeks a firestorm, emanating from the
red-meat and dairy industries, engulfed the committee, and Senator McGovern
(who had a great many cattle ranchers among his South Dakota constituents)
was forced to beat a retreat. The committee's recommendations were hastily
rewritten. Plain talk about food — the committee had advised Americans to
actually "reduce consumption of meat" — was replaced by artful compromise:
"Choose meats, poultry and fish that will reduce saturated-fat intake."

A subtle change in emphasis, you might say, but a world of difference just
the same. First, the stark message to "eat less" of a particular food has
been deep-sixed; don't look for it ever again in any official U.S. dietary
pronouncement. Second, notice how distinctions between entities as different
as fish and beef and chicken have collapsed; those three venerable foods,
each representing an entirely different taxonomic class, are now lumped
together as delivery systems for a single nutrient. Notice too how the new
language exonerates the foods themselves; now the culprit is an obscure,
invisible, tasteless — and politically unconnected — substance that may or
may not lurk in them called "saturated fat."

The linguistic capitulation did nothing to rescue McGovern from his blunder;
the very next election, in 1980, the beef lobby helped rusticate the
three-term senator, sending an unmistakable warning to anyone who would
challenge the American diet, and in particular the big chunk of animal
protein sitting in the middle of its plate. Henceforth, government dietary
guidelines would shun plain talk about whole foods, each of which has its
trade association on Capitol Hill, and would instead arrive clothed in
scientific euphemism and speaking of nutrients, entities that few Americans
really understood but that lack powerful lobbies in Washington. This was
precisely the tack taken by the National Academy of Sciences when it issued
its landmark report on diet and cancer in 1982. Organized nutrient by
nutrient in a way guaranteed to offend no food group, it codified the
official new dietary language. Industry and media followed suit, and terms
like polyunsaturated, cholesterol, monounsaturated, carbohydrate, fiber,
polyphenols, amino acids and carotenes soon colonized much of the cultural
space previously occupied by the tangible substance formerly known as food.
The Age of Nutritionism had arrived.

THE RISE OF NUTRITIONISM

The first thing to understand about nutritionism — I first encountered the
term in the work of an Australian sociologist of science named Gyorgy
Scrinis — is that it is not quite the same as nutrition. As the "ism"
suggests, it is not a scientific subject but an ideology. Ideologies are
ways of organizing large swaths of life and experience under a set of shared
but unexamined assumptions. This quality makes an ideology particularly hard
to see, at least while it's exerting its hold on your culture. A reigning
ideology is a little like the weather, all pervasive and virtually
inescapable. Still, we can try.

In the case of nutritionism, the widely shared but unexamined assumption is
that the key to understanding food is indeed the nutrient. From this basic
premise flow several others. Since nutrients, as compared with foods, are
invisible and therefore slightly mysterious, it falls to the scientists (and
to the journalists through whom the scientists speak) to explain the hidden
reality of foods to us. To enter a world in which you dine on unseen
nutrients, you need lots of expert help.

But expert help to do what, exactly? This brings us to another unexamined
assumption: that the whole point of eating is to maintain and promote bodily
health. Hippocrates's famous injunction to "let food be thy medicine" is
ritually invoked to support this notion. I'll leave the premise alone for
now, except to point out that it is not shared by all cultures and that the
experience of these other cultures suggests that, paradoxically, viewing
food as being about things other than bodily health — like pleasure, say, or
socializing — makes people no less healthy; indeed, there's some reason to
believe that it may make them more healthy. This is what we usually have in
mind when we speak of the "French paradox" — the fact that a population that
eats all sorts of unhealthful nutrients is in many ways healthier than we
Americans are. So there is at least a question as to whether nutritionism is
actually any good for you.

Another potentially serious weakness of nutritionist ideology is that it has
trouble discerning qualitative distinctions between foods. So fish, beef and
chicken through the nutritionists' lens become mere delivery systems for
varying quantities of fats and proteins and whatever other nutrients are on
their scope. Similarly, any qualitative distinctions between processed foods
and whole foods disappear when your focus is on quantifying the nutrients
they contain (or, more precisely, the known nutrients).

This is a great boon for manufacturers of processed food, and it helps
explain why they have been so happy to get with the nutritionism program. In
the years following McGovern's capitulation and the 1982 National Academy
report, the food industry set about re-engineering thousands of popular food
products to contain more of the nutrients that science and government had
deemed the good ones and less of the bad, and by the late '80s a golden era
of food science was upon us. The Year of Eating Oat Bran — also known as
1988 — served as a kind of coming-out party for the food scientists, who
succeeded in getting the material into nearly every processed food sold in
America. Oat bran's moment on the dietary stage didn't last long, but the
pattern had been established, and every few years since then a new oat bran
has taken its turn under the marketing lights. (Here comes omega-3!)

By comparison, the typical real food has more trouble competing under the
rules of nutritionism, if only because something like a banana or an avocado
can't easily change its nutritional stripes (though rest assured the genetic
engineers are hard at work on the problem). So far, at least, you can't put
oat bran in a banana. So depending on the reigning nutritional orthodoxy,
the avocado might be either a high-fat food to be avoided (Old Think) or a
food high in monounsaturated fat to be embraced (New Think). The fate of
each whole food rises and falls with every change in the nutritional
weather, while the processed foods are simply reformulated. That's why when
the Atkins mania hit the food industry, bread and pasta were given a quick
redesign (dialing back the carbs; boosting the protein), while the poor
unreconstructed potatoes and carrots were left out in the cold.

Of course it's also a lot easier to slap a health claim on a box of sugary
cereal than on a potato or carrot, with the perverse result that the most
healthful foods in the supermarket sit there quietly in the produce section,
silent as stroke victims, while a few aisles over, the Cocoa Puffs and Lucky
Charms are screaming about their newfound whole-grain goodness.

EAT RIGHT, GET FATTER

So nutritionism is good for business. But is it good for us? You might think
that a national fixation on nutrients would lead to measurable improvements
in the public health. But for that to happen, the underlying nutritional
science, as well as the policy recommendations (and the journalism) based on
that science, would have to be sound. This has seldom been the case.

Consider what happened immediately after the 1977 "Dietary Goals" —
McGovern's masterpiece of politico-nutritionist compromise. In the wake of
the panel's recommendation that we cut down on saturated fat, a
recommendation seconded by the 1982 National Academy report on cancer,
Americans did indeed change their diets, endeavoring for a quarter-century
to do what they had been told. Well, kind of. The industrial food supply was
promptly reformulated to reflect the official advice, giving us low-fat
pork, low-fat Snackwell's and all the low-fat pasta and high-fructose (yet
low-fat!) corn syrup we could consume. Which turned out to be quite a lot.
Oddly, America got really fat on its new low-fat diet — indeed, many date
the current obesity and diabetes epidemic to the late 1970s, when Americans
began binging on carbohydrates, ostensibly as a way to avoid the evils of
fat.

This story has been told before, notably in these pages ("What if It's All
Been a Big Fat Lie?" by Gary Taubes, July 7, 2002), but it's a little more
complicated than the official version suggests. In that version, which
inspired the most recent Atkins craze, we were told that America got fat
when, responding to bad scientific advice, it shifted its diet from fats to
carbs, suggesting that a re-evaluation of the two nutrients is in order: fat
doesn't make you fat; carbs do. (Why this should have come as news is a
mystery: as long as people have been raising animals for food, they have
fattened them on carbs.)

But there are a couple of problems with this revisionist picture. First,
while it is true that Americans post-1977 did begin binging on carbs, and
that fat as a percentage of total calories in the American diet declined, we
never did in fact cut down on our consumption of fat. Meat consumption
actually climbed. We just heaped a bunch more carbs onto our plates,
obscuring perhaps, but not replacing, the expanding chunk of animal protein
squatting in the center.

How did that happen? I would submit that the ideology of nutritionism
deserves as much of the blame as the carbohydrates themselves do — that and
human nature. By framing dietary advice in terms of good and bad nutrients,
and by burying the recommendation that we should eat less of any particular
food, it was easy for the take-home message of the 1977 and 1982 dietary
guidelines to be simplified as follows: Eat more low-fat foods. And that is
what we did. We're always happy to receive a dispensation to eat more of
something (with the possible exception of oat bran), and one of the things
nutritionism reliably gives us is some such dispensation: low-fat cookies
then, low-carb beer now. It's hard to imagine the low-fat craze taking off
as it did if McGovern's original food-based recommendations had stood: eat
fewer meat and dairy products. For how do you get from that stark counsel to
the idea that another case of Snackwell's is just what the doctor ordered?

BAD SCIENCE

But if nutritionism leads to a kind of false consciousness in the mind of
the eater, the ideology can just as easily mislead the scientist. Most
nutritional science involves studying one nutrient at a time, an approach
that even nutritionists who do it will tell you is deeply flawed. "The
problem with nutrient-by-nutrient nutrition science," points out Marion
Nestle, the New York University nutritionist, "is that it takes the nutrient
out of the context of food, the food out of the context of diet and the diet
out of the context of lifestyle."

If nutritional scientists know this, why do they do it anyway? Because a
nutrient bias is built into the way science is done: scientists need
individual variables they can isolate. Yet even the simplest food is a
hopelessly complex thing to study, a virtual wilderness of chemical
compounds, many of which exist in complex and dynamic relation to one
another, and all of which together are in the process of changing from one
state to another. So if you're a nutritional scientist, you do the only
thing you can do, given the tools at your disposal: break the thing down
into its component parts and study those one by one, even if that means
ignoring complex interactions and contexts, as well as the fact that the
whole may be more than, or just different from, the sum of its parts. This
is what we mean by reductionist science.

Scientific reductionism is an undeniably powerful tool, but it can mislead
us too, especially when applied to something as complex as, on the one side,
a food, and on the other, a human eater. It encourages us to take a
mechanistic view of that transaction: put in this nutrient; get out that
physiological result. Yet people differ in important ways. Some populations
can metabolize sugars better than others; depending on your evolutionary
heritage, you may or may not be able to digest the lactose in milk. The
specific ecology of your intestines helps determine how efficiently you
digest what you eat, so that the same input of 100 calories may yield more
or less energy depending on the proportion of Firmicutes and Bacteroidetes
living in your gut. There is nothing very machinelike about the human eater,
and so to think of food as simply fuel is wrong.

Also, people don't eat nutrients, they eat foods, and foods can behave very
differently than the nutrients they contain. Researchers have long believed,
based on epidemiological comparisons of different populations, that a diet
high in fruits and vegetables confers some protection against cancer. So
naturally they ask, What nutrients in those plant foods are responsible for
that effect? One hypothesis is that the antioxidants in fresh produce —
compounds like beta carotene, lycopene, vitamin E, etc. — are the X factor.
It makes good sense: these molecules (which plants produce to protect
themselves from the highly reactive oxygen atoms produced in photosynthesis)
vanquish the free radicals in our bodies, which can damage DNA and initiate
cancers. At least that's how it seems to work in the test tube. Yet as soon
as you remove these useful molecules from the context of the whole foods
they're found in, as we've done in creating antioxidant supplements, they
don't work at all. Indeed, in the case of beta carotene ingested as a
supplement, scientists have discovered that it actually increases the risk
of certain cancers. Big oops.

What's going on here? We don't know. It could be the vagaries of human
digestion. Maybe the fiber (or some other component) in a carrot protects
the antioxidant molecules from destruction by stomach acids early in the
digestive process. Or it could be that we isolated the wrong antioxidant.
Beta is just one of a whole slew of carotenes found in common vegetables;
maybe we focused on the wrong one. Or maybe beta carotene works as an
antioxidant only in concert with some other plant chemical or process; under
other circumstances, it may behave as a pro-oxidant.

Indeed, to look at the chemical composition of any common food plant is to
realize just how much complexity lurks within it. Here's a list of just the
antioxidants that have been identified in garden-variety thyme:

4-Terpineol, alanine, anethole, apigenin, ascorbic acid, beta carotene,
caffeic acid, camphene, carvacrol, chlorogenic acid, chrysoeriol,
eriodictyol, eugenol, ferulic acid, gallic acid, gamma-terpinene
isochlorogenic acid, isoeugenol, isothymonin, kaempferol, labiatic acid,
lauric acid, linalyl acetate, luteolin, methionine, myrcene, myristic acid,
naringenin, oleanolic acid, p-coumoric acid, p-hydroxy-benzoic acid,
palmitic acid, rosmarinic acid, selenium, tannin, thymol, tryptophan,
ursolic acid, vanillic acid.

This is what you're ingesting when you eat food flavored with thyme. Some of
these chemicals are broken down by your digestion, but others are going on
to do undetermined things to your body: turning some gene's expression on or
off, perhaps, or heading off a free radical before it disturbs a strand of
DNA deep in some cell. It would be great to know how this all works, but in
the meantime we can enjoy thyme in the knowledge that it probably doesn't do
any harm (since people have been eating it forever) and that it may actually
do some good (since people have been eating it forever) and that even if it
does nothing, we like the way it tastes.

It's also important to remind ourselves that what reductive science can
manage to perceive well enough to isolate and study is subject to change,
and that we have a tendency to assume that what we can see is all there is
to see. When William Prout isolated the big three macronutrients, scientists
figured they now understood food and what the body needs from it; when the
vitamins were isolated a few decades later, scientists thought, O.K., now we
really understand food and what the body needs to be healthy; today it's the
polyphenols and carotenoids that seem all-important. But who knows what the
hell else is going on deep in the soul of a carrot?

The good news is that, to the carrot eater, it doesn't matter. That's the
great thing about eating food as compared with nutrients: you don't need to
fathom a carrot's complexity to reap its benefits.

The case of the antioxidants points up the dangers in taking a nutrient out
of the context of food; as Nestle suggests, scientists make a second,
related error when they study the food out of the context of the diet. We
don't eat just one thing, and when we are eating any one thing, we're not
eating another. We also eat foods in combinations and in orders that can
affect how they're absorbed. Drink coffee with your steak, and your body
won't be able to fully absorb the iron in the meat. The trace of limestone
in the corn tortilla unlocks essential amino acids in the corn that would
otherwise remain unavailable. Some of those compounds in that sprig of thyme
may well affect my digestion of the dish I add it to, helping to break down
one compound or possibly stimulate production of an enzyme to detoxify
another. We have barely begun to understand the relationships among foods in
a cuisine.

But we do understand some of the simplest relationships, like the zero-sum
relationship: that if you eat a lot of meat you're probably not eating a lot
of vegetables. This simple fact may explain why populations that eat diets
high in meat have higher rates of coronary heart disease and cancer than
those that don't. Yet nutritionism encourages us to look elsewhere for the
explanation: deep within the meat itself, to the culpable nutrient, which
scientists have long assumed to be the saturated fat. So they are baffled
when large-population studies, like the Women's Health Initiative, fail to
find that reducing fat intake significantly reduces the incidence of heart
disease or cancer.

Of course thanks to the low-fat fad (inspired by the very same reductionist
fat hypothesis), it is entirely possible to reduce your intake of saturated
fat without significantly reducing your consumption of animal protein: just
drink the low-fat milk and order the skinless chicken breast or the turkey
bacon. So maybe the culprit nutrient in meat and dairy is the animal protein
itself, as some researchers now hypothesize. (The Cornell nutritionist T.
Colin Campbell argues as much in his recent book, "The China Study.") Or, as
the Harvard epidemiologist Walter C. Willett suggests, it could be the
steroid hormones typically present in the milk and meat; these hormones
(which occur naturally in meat and milk but are often augmented in
industrial production) are known to promote certain cancers.

But people worried about their health needn't wait for scientists to settle
this question before deciding that it might be wise to eat more plants and
less meat. This is of course precisely what the McGovern committee was
trying to tell us.

Nestle also cautions against taking the diet out of the context of the
lifestyle. The Mediterranean diet is widely believed to be one of the most
healthful ways to eat, yet much of what we know about it is based on studies
of people living on the island of Crete in the 1950s, who in many respects
lived lives very different from our own. Yes, they ate lots of olive oil and
little meat. But they also did more physical labor. They fasted regularly.
They ate a lot of wild greens — weeds. And, perhaps most important, they
consumed far fewer total calories than we do. Similarly, much of what we
know about the health benefits of a vegetarian diet is based on studies of
Seventh Day Adventists, who muddy the nutritional picture by drinking
absolutely no alcohol and never smoking. These extraneous but unavoidable
factors are called, aptly, "confounders." One last example: People who take
supplements are healthier than the population at large, but their health
probably has nothing whatsoever to do with the supplements they take — which
recent studies have suggested are worthless. Supplement-takers are
better-educated, more-affluent people who, almost by definition, take a
greater-than-normal interest in personal health — confounding factors that
probably account for their superior health.

But if confounding factors of lifestyle bedevil comparative studies of
different populations, the supposedly more rigorous "prospective" studies of
large American populations suffer from their own arguably even more
disabling flaws. In these studies — of which the Women's Health Initiative
is the best known — a large population is divided into two groups. The
intervention group changes its diet in some prescribed manner, while the
control group does not. The two groups are then tracked over many years to
learn whether the intervention affects relative rates of chronic disease.

When it comes to studying nutrition, this sort of extensive, long-term
clinical trial is supposed to be the gold standard. It certainly sounds
sound. In the case of the Women's Health Initiative, sponsored by the
National Institutes of Health, the eating habits and health outcomes of
nearly 49,000 women (ages 50 to 79 at the beginning of the study) were
tracked for eight years. One group of the women were told to reduce their
consumption of fat to 20 percent of total calories. The results were
announced early last year, producing front-page headlines of which the one
in this newspaper was typical: "Low-Fat Diet Does Not Cut Health Risks,
Study Finds." And the cloud of nutritional confusion over the country
darkened.

But even a cursory analysis of the study's methods makes you wonder why
anyone would take such a finding seriously, let alone order a Quarter
Pounder With Cheese to celebrate it, as many newspaper readers no doubt
promptly went out and did. Even the beginner student of nutritionism will
immediately spot several flaws: the focus was on "fat," rather than on any
particular food, like meat or dairy. So women could comply simply by
switching to lower-fat animal products. Also, no distinctions were made
between types of fat: women getting their allowable portion of fat from
olive oil or fish were lumped together with woman getting their fat from
low-fat cheese or chicken breasts or margarine. Why? Because when the study
was designed 16 years ago, the whole notion of "good fats" was not yet on
the scientific scope. Scientists study what scientists can see.

But perhaps the biggest flaw in this study, and other studies like it, is
that we have no idea what these women were really eating because, like most
people when asked about their diet, they lied about it. How do we know this?
Deduction. Consider: When the study began, the average participant weighed
in at 170 pounds and claimed to be eating 1,800 calories a day. It would
take an unusual metabolism to maintain that weight on so little food. And it
would take an even freakier metabolism to drop only one or two pounds after
getting down to a diet of 1,400 to 1,500 calories a day — as the women on
the "low-fat" regimen claimed to have done. Sorry, ladies, but I just don't
buy it.

In fact, nobody buys it. Even the scientists who conduct this sort of
research conduct it in the knowledge that people lie about their food intake
all the time. They even have scientific figures for the magnitude of the
lie. Dietary trials like the Women's Health Initiative rely on
"food-frequency questionnaires," and studies suggest that people on average
eat between a fifth and a third more than they claim to on the
questionnaires. How do the researchers know that? By comparing what people
report on questionnaires with interviews about their dietary intake over the
previous 24 hours, thought to be somewhat more reliable. In fact, the
magnitude of the lie could be much greater, judging by the huge disparity
between the total number of food calories produced every day for each
American (3,900 calories) and the average number of those calories Americans
own up to chomping: 2,000. (Waste accounts for some of the disparity, but
nowhere near all of it.) All we really know about how much people actually
eat is that the real number lies somewhere between those two figures.

To try to fill out the food-frequency questionnaire used by the Women's
Health Initiative, as I recently did, is to realize just how shaky the data
on which such trials rely really are. The survey, which took about 45
minutes to complete, started off with some relatively easy questions: "Did
you eat chicken or turkey during the last three months?" Having answered
yes, I was then asked, "When you ate chicken or turkey, how often did you
eat the skin?" But the survey soon became harder, as when it asked me to
think back over the past three months to recall whether when I ate okra,
squash or yams, they were fried, and if so, were they fried in stick
margarine, tub margarine, butter, "shortening" (in which category they
inexplicably lump together hydrogenated vegetable oil and lard), olive or
canola oil or nonstick spray? I honestly didn't remember, and in the case of
any okra eaten in a restaurant, even a hypnotist could not get out of me
what sort of fat it was fried in. In the meat section, the portion sizes
specified haven't been seen in America since the Hoover administration. If a
four-ounce portion of steak is considered "medium," was I really going to
admit that the steak I enjoyed on an unrecallable number of occasions during
the past three months was probably the equivalent of two or three (or, in
the case of a steakhouse steak, no less than four) of these portions? I
think not. In fact, most of the "medium serving sizes" to which I was asked
to compare my own consumption made me feel piggish enough to want to shave a
few ounces here, a few there. (I mean, I wasn't under oath or anything, was
I?)

This is the sort of data on which the largest questions of diet and health
are being decided in America today.

THE ELEPHANT IN THE ROOM

In the end, the biggest, most ambitious and widely reported studies of diet
and health leave more or less undisturbed the main features of the Western
diet: lots of meat and processed foods, lots of added fat and sugar, lots of
everything — except fruits, vegetables and whole grains. In keeping with the
nutritionism paradigm and the limits of reductionist science, the
researchers fiddle with single nutrients as best they can, but the
populations they recruit and study are typical American eaters doing what
typical American eaters do: trying to eat a little less of this nutrient, a
little more of that, depending on the latest thinking. (One problem with the
control groups in these studies is that they too are exposed to nutritional
fads in the culture, so over time their eating habits come to more closely
resemble the habits of the intervention group.) It should not surprise us
that the findings of such research would be so equivocal and confusing.

But what about the elephant in the room — the Western diet? It might be
useful, in the midst of our deepening confusion about nutrition, to review
what we do know about diet and health. What we know is that people who eat
the way we do in America today suffer much higher rates of cancer, heart
disease, diabetes and obesity than people eating more traditional diets.
(Four of the 10 leading killers in America are linked to diet.) Further, we
know that simply by moving to America, people from nations with low rates of
these "diseases of affluence" will quickly acquire them. Nutritionism by and
large takes the Western diet as a given, seeking to moderate its most
deleterious effects by isolating the bad nutrients in it — things like fat,
sugar, salt — and encouraging the public and the food industry to limit
them. But after several decades of nutrient-based health advice, rates of
cancer and heart disease in the U.S. have declined only slightly (mortality
from heart disease is down since the '50s, but this is mainly because of
improved treatment), and rates of obesity and diabetes have soared.

No one likes to admit that his or her best efforts at understanding and
solving a problem have actually made the problem worse, but that's exactly
what has happened in the case of nutritionism. Scientists operating with the
best of intentions, using the best tools at their disposal, have taught us
to look at food in a way that has diminished our pleasure in eating it while
doing little or nothing to improve our health. Perhaps what we need now is a
broader, less reductive view of what food is, one that is at once more
ecological and cultural. What would happen, for example, if we were to start
thinking about food as less of a thing and more of a relationship?

In nature, that is of course precisely what eating has always been:
relationships among species in what we call food chains, or webs, that reach
all the way down to the soil. Species co-evolve with the other species they
eat, and very often a relationship of interdependence develops: I'll feed
you if you spread around my genes. A gradual process of mutual adaptation
transforms something like an apple or a squash into a nutritious and tasty
food for a hungry animal. Over time and through trial and error, the plant
becomes tastier (and often more conspicuous) in order to gratify the
animal's needs and desires, while the animal gradually acquires whatever
digestive tools (enzymes, etc.) are needed to make optimal use of the plant.
Similarly, cow's milk did not start out as a nutritious food for humans; in
fact, it made them sick until humans who lived around cows evolved the
ability to digest lactose as adults. This development proved much to the
advantage of both the milk drinkers and the cows.

"Health" is, among other things, the byproduct of being involved in these
sorts of relationships in a food chain — involved in a great many of them,
in the case of an omnivorous creature like us. Further, when the health of
one link of the food chain is disturbed, it can affect all the creatures in
it. When the soil is sick or in some way deficient, so will be the grasses
that grow in that soil and the cattle that eat the grasses and the people
who drink the milk. Or, as the English agronomist Sir Albert Howard put it
in 1945 in "The Soil and Health" (a founding text of organic agriculture),
we would do well to regard "the whole problem of health in soil, plant,
animal and man as one great subject." Our personal health is inextricably
bound up with the health of the entire food web.

In many cases, long familiarity between foods and their eaters leads to
elaborate systems of communications up and down the food chain, so that a
creature's senses come to recognize foods as suitable by taste and smell and
color, and our bodies learn what to do with these foods after they pass the
test of the senses, producing in anticipation the chemicals necessary to
break them down. Health depends on knowing how to read these biological
signals: this smells spoiled; this looks ripe; that's one good-looking cow.
This is easier to do when a creature has long experience of a food, and much
harder when a food has been designed expressly to deceive its senses — with
artificial flavors, say, or synthetic sweeteners.

Note that these ecological relationships are between eaters and whole foods,
not nutrients. Even though the foods in question eventually get broken down
in our bodies into simple nutrients, as corn is reduced to simple sugars,
the qualities of the whole food are not unimportant — they govern such
things as the speed at which the sugars will be released and absorbed, which
we're coming to see as critical to insulin metabolism. Put another way, our
bodies have a longstanding and sustainable relationship to corn that we do
not have to high-fructose corn syrup. Such a relationship with corn syrup
might develop someday (as people evolve superhuman insulin systems to cope
with regular floods of fructose and glucose), but for now the relationship
leads to ill health because our bodies don't know how to handle these
biological novelties. In much the same way, human bodies that can cope with
chewing coca leaves — a longstanding relationship between native people and
the coca plant in South America — cannot cope with cocaine or crack, even
though the same "active ingredients" are present in all three. Reductionism
as a way of understanding food or drugs may be harmless, even necessary, but
reductionism in practice can lead to problems.

Looking at eating through this ecological lens opens a whole new perspective
on exactly what the Western diet is: a radical and rapid change not just in
our foodstuffs over the course of the 20th century but also in our food
relationships, all the way from the soil to the meal. The ideology of
nutritionism is itself part of that change. To get a firmer grip on the
nature of those changes is to begin to know how we might make our
relationships to food healthier. These changes have been numerous and
far-reaching, but consider as a start these four large-scale ones:

>From Whole Foods to Refined. The case of corn points up one of the key
features of the modern diet: a shift toward increasingly refined foods,
especially carbohydrates. Call it applied reductionism. Humans have been
refining grains since at least the Industrial Revolution, favoring white
flour (and white rice) even at the price of lost nutrients. Refining grains
extends their shelf life (precisely because it renders them less nutritious
to pests) and makes them easier to digest, by removing the fiber that
ordinarily slows the release of their sugars. Much industrial food
production involves an extension and intensification of this practice, as
food processors find ways to deliver glucose — the brain's preferred fuel —
ever more swiftly and efficiently. Sometimes this is precisely the point, as
when corn is refined into corn syrup; other times it is an unfortunate
byproduct of food processing, as when freezing food destroys the fiber that
would slow sugar absorption.

So fast food is fast in this other sense too: it is to a considerable extent
predigested, in effect, and therefore more readily absorbed by the body. But
while the widespread acceleration of the Western diet offers us the instant
gratification of sugar, in many people (and especially those newly exposed
to it) the "speediness" of this food overwhelms the insulin response and
leads to Type II diabetes. As one nutrition expert put it to me, we're in
the middle of "a national experiment in mainlining glucose." To encounter
such a diet for the first time, as when people accustomed to a more
traditional diet come to America, or when fast food comes to their
countries, delivers a shock to the system. Public-health experts call it
"the nutrition transition," and it can be deadly.

>From Complexity to Simplicity. If there is one word that covers nearly all
the changes industrialization has made to the food chain, it would be
simplification. Chemical fertilizers simplify the chemistry of the soil,
which in turn appears to simplify the chemistry of the food grown in that
soil. Since the widespread adoption of synthetic nitrogen fertilizers in the
1950s, the nutritional quality of produce in America has, according to
U.S.D.A. figures, declined significantly. Some researchers blame the quality
of the soil for the decline; others cite the tendency of modern plant
breeding to select for industrial qualities like yield rather than
nutritional quality. Whichever it is, the trend toward simplification of our
food continues on up the chain. Processing foods depletes them of many
nutrients, a few of which are then added back in through "fortification":
folic acid in refined flour, vitamins and minerals in breakfast cereal. But
food scientists can add back only the nutrients food scientists recognize as
important. What are they overlooking?

Simplification has occurred at the level of species diversity, too. The
astounding variety of foods on offer in the modern supermarket obscures the
fact that the actual number of species in the modern diet is shrinking. For
reasons of economics, the food industry prefers to tease its myriad
processed offerings from a tiny group of plant species, corn and soybeans
chief among them. Today, a mere four crops account for two-thirds of the
calories humans eat. When you consider that humankind has historically
consumed some 80,000 edible species, and that 3,000 of these have been in
widespread use, this represents a radical simplification of the food web.
Why should this matter? Because humans are omnivores, requiring somewhere
between 50 and 100 different chemical compounds and elements to be healthy.
It's hard to believe that we can get everything we need from a diet
consisting largely of processed corn, soybeans, wheat and rice.

>From Leaves to Seeds. It's no coincidence that most of the plants we have
come to rely on are grains; these crops are exceptionally efficient at
transforming sunlight into macronutrients — carbs, fats and proteins. These
macronutrients in turn can be profitably transformed into animal protein (by
feeding them to animals) and processed foods of every description. Also, the
fact that grains are durable seeds that can be stored for long periods means
they can function as commodities as well as food, making these plants
particularly well suited to the needs of industrial capitalism.

The needs of the human eater are another matter. An oversupply of
macronutrients, as we now have, itself represents a serious threat to our
health, as evidenced by soaring rates of obesity and diabetes. But the
undersupply of micronutrients may constitute a threat just as serious. Put
in the simplest terms, we're eating a lot more seeds and a lot fewer leaves,
a tectonic dietary shift the full implications of which we are just
beginning to glimpse. If I may borrow the nutritionist's reductionist
vocabulary for a moment, there are a host of critical micronutrients that
are harder to get from a diet of refined seeds than from a diet of leaves.
There are the antioxidants and all the other newly discovered phytochemicals
(remember that sprig of thyme?); there is the fiber, and then there are the
healthy omega-3 fats found in leafy green plants, which may turn out to be
most important benefit of all.

Most people associate omega-3 fatty acids with fish, but fish get them from
green plants (specifically algae), which is where they all originate. Plant
leaves produce these essential fatty acids ("essential" because our bodies
can't produce them on their own) as part of photosynthesis. Seeds contain
more of another essential fatty acid: omega-6. Without delving too deeply
into the biochemistry, the two fats perform very different functions, in the
plant as well as the plant eater. Omega-3s appear to play an important role
in neurological development and processing, the permeability of cell walls,
the metabolism of glucose and the calming of inflammation. Omega-6s are
involved in fat storage (which is what they do for the plant), the rigidity
of cell walls, clotting and the inflammation response. (Think of omega-3s as
fleet and flexible, omega-6s as sturdy and slow.) Since the two lipids
compete with each other for the attention of important enzymes, the ratio
between omega-3s and omega-6s may matter more than the absolute quantity of
either fat. Thus too much omega-6 may be just as much a problem as too
little omega-3.

And that might well be a problem for people eating a Western diet. As we've
shifted from leaves to seeds, the ratio of omega-6s to omega-3s in our
bodies has shifted, too. At the same time, modern food-production practices
have further diminished the omega-3s in our diet. Omega-3s, being less
stable than omega-6s, spoil more readily, so we have selected for plants
that produce fewer of them; further, when we partly hydrogenate oils to
render them more stable, omega-3s are eliminated. Industrial meat, raised on
seeds rather than leaves, has fewer omega-3s and more omega-6s than
preindustrial meat used to have. And official dietary advice since the 1970s
has promoted the consumption of polyunsaturated vegetable oils, most of
which are high in omega-6s (corn and soy, especially). Thus, without
realizing what we were doing, we significantly altered the ratio of these
two essential fats in our diets and bodies, with the result that the ratio
of omega-6 to omega-3 in the typical American today stands at more than 10
to 1; before the widespread introduction of seed oils at the turn of the
last century, it was closer to 1 to 1.

The role of these lipids is not completely understood, but many researchers
say that these historically low levels of omega-3 (or, conversely, high
levels of omega-6) bear responsibility for many of the chronic diseases
associated with the Western diet, especially heart disease and diabetes.
(Some researchers implicate omega-3 deficiency in rising rates of depression
and learning disabilities as well.) To remedy this deficiency, nutritionism
classically argues for taking omega-3 supplements or fortifying food
products, but because of the complex, competitive relationship between
omega-3 and omega-6, adding more omega-3s to the diet may not do much good
unless you also reduce your intake of omega-6.

>From Food Culture to Food Science. The last important change wrought by the
Western diet is not, strictly speaking, ecological. But the
industrialization of our food that we call the Western diet is
systematically destroying traditional food cultures. Before the modern food
era — and before nutritionism — people relied for guidance about what to eat
on their national or ethnic or regional cultures. We think of culture as a
set of beliefs and practices to help mediate our relationship to other
people, but of course culture (at least before the rise of science) has also
played a critical role in helping mediate people's relationship to nature.
Eating being a big part of that relationship, cultures have had a great deal
to say about what and how and why and when and how much we should eat. Of
course when it comes to food, culture is really just a fancy word for Mom,
the figure who typically passes on the food ways of the group — food ways
that, although they were never "designed" to optimize health (we have many
reasons to eat the way we do), would not have endured if they did not keep
eaters alive and well.

The sheer novelty and glamour of the Western diet, with its 17,000 new food
products introduced every year, and the marketing muscle used to sell these
products, has overwhelmed the force of tradition and left us where we now
find ourselves: relying on science and journalism and marketing to help us
decide questions about what to eat. Nutritionism, which arose to help us
better deal with the problems of the Western diet, has largely been co-opted
by it, used by the industry to sell more food and to undermine the authority
of traditional ways of eating. You would not have read this far into this
article if your food culture were intact and healthy; you would simply eat
the way your parents and grandparents and great-grandparents taught you to
eat. The question is, Are we better off with these new authorities than we
were with the traditional authorities they supplanted? The answer by now
should be clear.

It might be argued that, at this point in history, we should simply accept
that fast food is our food culture. Over time, people will get used to
eating this way and our health will improve. But for natural selection to
help populations adapt to the Western diet, we'd have to be prepared to let
those whom it sickens die. That's not what we're doing. Rather, we're
turning to the health-care industry to help us "adapt." Medicine is learning
how to keep alive the people whom the Western diet is making sick. It's
gotten good at extending the lives of people with heart disease, and now
it's working on obesity and diabetes. Capitalism is itself marvelously
adaptive, able to turn the problems it creates into lucrative business
opportunities: diet pills, heart-bypass operations, insulin pumps, bariatric
surgery. But while fast food may be good business for the health-care
industry, surely the cost to society — estimated at more than $200 billion a
year in diet-related health-care costs — is unsustainable.

BEYOND NUTRITIONISM

To medicalize the diet problem is of course perfectly consistent with
nutritionism. So what might a more ecological or cultural approach to the
problem recommend? How might we plot our escape from nutritionism and, in
turn, from the deleterious effects of the modern diet? In theory nothing
could be simpler — stop thinking and eating that way — but this is somewhat
harder to do in practice, given the food environment we now inhabit and the
loss of sharp cultural tools to guide us through it. Still, I do think
escape is possible, to which end I can now revisit — and elaborate on, but
just a little — the simple principles of healthy eating I proposed at the
beginning of this essay, several thousand words ago. So try these few
(flagrantly unscientific) rules of thumb, collected in the course of my
nutritional odyssey, and see if they don't at least point us in the right
direction.

1. Eat food. Though in our current state of confusion, this is much easier
said than done. So try this: Don't eat anything your great-great-grandmother
wouldn't recognize as food. (Sorry, but at this point Moms are as confused
as the rest of us, which is why we have to go back a couple of generations,
to a time before the advent of modern food products.) There are a great many
foodlike items in the supermarket your ancestors wouldn't recognize as food
(Go-Gurt? Breakfast-cereal bars? Nondairy creamer?); stay away from these.

2. Avoid even those food products that come bearing health claims. They're
apt to be heavily processed, and the claims are often dubious at best. Don't
forget that margarine, one of the first industrial foods to claim that it
was more healthful than the traditional food it replaced, turned out to give
people heart attacks. When Kellogg's can boast about its Healthy Heart
Strawberry Vanilla cereal bars, health claims have become hopelessly
compromised. (The American Heart Association charges food makers for their
endorsement.) Don't take the silence of the yams as a sign that they have
nothing valuable to say about health.

3. Especially avoid food products containing ingredients that are a)
unfamiliar, b) unpronounceable c) more than five in number — or that contain
high-fructose corn syrup.None of these characteristics are necessarily
harmful in and of themselves, but all of them are reliable markers for foods
that have been highly processed.

4. Get out of the supermarket whenever possible. You won't find any
high-fructose corn syrup at the farmer's market; you also won't find food
harvested long ago and far away. What you will find are fresh whole foods
picked at the peak of nutritional quality. Precisely the kind of food your
great-great-grandmother would have recognized as food.

5. Pay more, eat less. The American food system has for a century devoted
its energies and policies to increasing quantity and reducing price, not to
improving quality. There's no escaping the fact that better food — measured
by taste or nutritional quality (which often correspond) — costs more,
because it has been grown or raised less intensively and with more care. Not
everyone can afford to eat well in America, which is shameful, but most of
us can: Americans spend, on average, less than 10 percent of their income on
food, down from 24 percent in 1947, and less than the citizens of any other
nation. And those of us who can afford to eat well should. Paying more for
food well grown in good soils — whether certified organic or not — will
contribute not only to your health (by reducing exposure to pesticides) but
also to the health of others who might not themselves be able to afford that
sort of food: the people who grow it and the people who live downstream, and
downwind, of the farms where it is grown.

"Eat less" is the most unwelcome advice of all, but in fact the scientific
case for eating a lot less than we currently do is compelling. "Calorie
restriction" has repeatedly been shown to slow aging in animals, and many
researchers (including Walter Willett, the Harvard epidemiologist) believe
it offers the single strongest link between diet and cancer prevention. Food
abundance is a problem, but culture has helped here, too, by promoting the
idea of moderation. Once one of the longest-lived people on earth, the
Okinawans practiced a principle they called "Hara Hachi Bu": eat until you
are 80 percent full. To make the "eat less" message a bit more palatable,
consider that quality may have a bearing on quantity: I don't know about
you, but the better the quality of the food I eat, the less of it I need to
feel satisfied. All tomatoes are not created equal.

6. Eat mostly plants, especially leaves. Scientists may disagree on what's
so good about plants — the antioxidants? Fiber? Omega-3s? — but they do
agree that they're probably really good for you and certainly can't hurt.
Also, by eating a plant-based diet, you'll be consuming far fewer calories,
since plant foods (except seeds) are typically less "energy dense" than the
other things you might eat. Vegetarians are healthier than carnivores, but
near vegetarians ("flexitarians") are as healthy as vegetarians. Thomas
Jefferson was on to something when he advised treating meat more as a
flavoring than a food.

7. Eat more like the French. Or the Japanese. Or the Italians. Or the
Greeks. Confounding factors aside, people who eat according to the rules of
a traditional food culture are generally healthier than we are. Any
traditional diet will do: if it weren't a healthy diet, the people who
follow it wouldn't still be around. True, food cultures are embedded in
societies and economies and ecologies, and some of them travel better than
others: Inuit not so well as Italian. In borrowing from a food culture, pay
attention to how a culture eats, as well as to what it eats. In the case of
the French paradox, it may not be the dietary nutrients that keep the French
healthy (lots of saturated fat and alcohol?!) so much as the dietary habits:
small portions, no seconds or snacking, communal meals — and the serious
pleasure taken in eating. (Worrying about diet can't possibly be good for
you.) Let culture be your guide, not science.

8. Cook. And if you can, plant a garden. To take part in the intricate and
endlessly interesting processes of providing for our sustenance is the
surest way to escape the culture of fast food and the values implicit in it:
that food should be cheap and easy; that food is fuel and not communion. The
culture of the kitchen, as embodied in those enduring traditions we call
cuisines, contains more wisdom about diet and health than you are apt to
find in any nutrition journal or journalism. Plus, the food you grow
yourself contributes to your health long before you sit down to eat it. So
you might want to think about putting down this article now and picking up a
spatula or hoe.

9. Eat like an omnivore. Try to add new species, not just new foods, to your
diet. The greater the diversity of species you eat, the more likely you are
to cover all your nutritional bases. That of course is an argument from
nutritionism, but there is a better one, one that takes a broader view of
"health." Biodiversity in the diet means less monoculture in the fields.
What does that have to do with your health? Everything. The vast
monocultures that now feed us require tremendous amounts of chemical
fertilizers and pesticides to keep from collapsing. Diversifying those
fields will mean fewer chemicals, healthier soils, healthier plants and
animals and, in turn, healthier people. It's all connected, which is another
way of saying that your health isn't bordered by your body and that what's
good for the soil is probably good for you, too.
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