How YOU View Food & Health: “And the Survey Says…”

 

…you’re confused!

The International Food Information Council (IFIC) recently released its 2017 “Food & Health Survey: A Healthy Perspective: Understanding American Food Values” all about consumers’ beliefs and behaviors around food.

To “cut-to-the-chase,” consumers are confused!  How confused are they?  Here are some highlights:

  • 4 in 5 admit finding conflicting information about food and nutrition.
  • Over half say this confusion gives them doubts about their food choices (maybe agita, too?)
  • 24 out of 25 people do seek out health benefits form the foods they choose, but less than half of those people could identify even one food or nutrient linked to those benefits!

Friends & Family: The New “Nutritionists”

More than 3 in 4 consumers actually rely on the people closest to them for at least some of their nutrition advice.  They’re skeptical about it, though.  About 7 in 10 don’t exactly have high trust in these folks for nutrition and food safety info.   Friends and family mean well and don’t speak “nutrition-ese”, so they’re easy to listen to.

This “hallway advice” however, has a downside: inaccurate or incomplete information fuels food and nutrition myths.  No one wants to make food decisions and purchases based on flawed assumptions.  Here’s what the IFIC survey had to say about that:

  • If a food costs $2, you are more likely to think it’s healthier than an IDENTICAL food that costs 99 cents.
  • You’re four times as likely to think fresh food is healthier than frozen
  • You’re five times as likely to think fresh is healthier than canned

Let’s at least clear some confusion about the above points:

  • Higher price – for the exact same item – is no indication of healthfulness.
  • Frozen can actually be higher in nutrients. Nowadays, frozen produce is quick frozen right on the field as it’s harvested.  That helps it retain nutrients that can be lost during the time it takes for the fresh version to go from farm to store, to your refrigerator – where you may wait a few days to prepare and eat it.
  • Canned foods vs. fresh? It depends.  Canned garbanzo and kidney beans?  Super nutritious.  I always keep them around.  Canned tomato paste is just condensed, concentrated tomatoes, and cooking tomatoes makes more of the antioxidant lycopene available.  Two thumbs up.  Canned fruit with lots of syrup?  Fresh or frozen fruit is a better choice most of the time, and it does have more fiber. Of course, context is everything: a canned peach with some vanilla Greek yogurt will have way fewer calories and more protein than a slice of cheesecake.

Let’s Clear the Air

As a clinician of over 30 years, I try every which way to make certain that a patient in my office leaves with clarity, not confusion.  Why? Because a confident patient/consumer is motivated to make positive changes!  A confused consumer says, “no” and stays put.  Exactly what I don’t want. Eating is more than just nutrition.  It’s about enjoyment.  If you’re confused or conflicted, where’s the fun?

Resolving conflict

Consumers said they trusted health professionals, especially registered dietitian/nutritionists (RDN), the most, even if they didn’t go to them as often as other sources.  It might be worth it to have a chat with an RDN.  It’ll help stop your confusion about food and get you more confident about the choices you make. As my colleague Carolyn O’Neil says, “The more you know, the more you can eat.”

Another way to clear the confusion? Sign up for my newsletter.  That’s an easy, positive change right there.

 

FRUITS & VEGGIES & PESTICIDES, OH MY!

As a kid I waited impatiently for summer. The main reason? The huge variety of fruits.  People think I love fruit because I’m a registered dietitian/nutritionist, but I’ve always been this way.  As a kid,

I remember going berry-picking near the weekend place we had as a kid, in this secluded canyon an hour south of San Francisco.  The blackberries were so sweet in the warm sun that I’d happily get scratched by the bush’s thorns just to reach the branches with the biggest berries. About half of what I picked didn’t make it home — I ate ‘em on the spot.  Yes, I should have washed them and no, I didn’t.  They were wild, but had plenty of dust and dirt.  I lived through it.

As an adult, my produce passion has only expanded.  I never met a grilled, roasted, or even steamed veggie I didn’t like (unless it was overcooked!)

Less is not more

The diet histories I take on all my patients show one constant: a lack of fruits and vegetables.  They’re like most Americans, too, according to the 2015 US Dietary Guidelines. Produce is a powerhouse of nutrients – and taste!  There’s just no substitute nutritionally, so why deprive ourselves?.

What’s the barrier to eating more produce? Check these frequent comments from patients:

  • “They have so many pesticides and organic stuff is too expensive.’
  • “I buy them but nobody eats them so it’s money down the drain.”
  • Fresh is too expensive and frozen and canned don’t have any nutrition left in them.”

A 2016 survey that looked at the attitudes of low-income consumers about organic vs. conventionally grown produce.  If they’d heard about pesticide residues on fruits and vegetables they were more likely to avoid buying them.  They’re definitely misinformed, because their fear is unfounded. Conventionally-grown fruits and vegetables are quite safe to eat.  Let’s look at why that’s so.

Pesticides 101: Testing, testing…

The Environmental Protection Agency (EPA) requires all pesticides to undergo hundreds of health, safety, and environmental tests before they’re approved. They also establish a safe “­reference dose”, or RfD level. To do this, they first establish the maximum amount of the pesticide that, if consumed daily for the rest of one’s life, would cause no harm. They make the RfD is then 1/1000th of that maximum safe dose.  That means that even if you got 1000 times the RfD, every day, you’d still be fine.

Then there’s verification.  The Pesticide Data Program (PDP) maintains the world’s most thorough database of pesticide residues.  It annually tests domestically-grown and imported produce. Over the 20 years of testing that the PDP has done, over 99% of crops have tested below RfD levels.  The vast majority of produce has tested ridiculously low, in fact, often 1/10,000th of acceptable levels – which already have a 1000-fold cushion in them.

Reality check

Carolyn O’Neil, registered dietitian, veteran food & nutrition reporter, author of The Slim Down South cookbook, says, “I have absolute confidence that choosing conventionally grown produce is doing only good things for you and your family.”  She doesn’t believe we have choose between organic or conventional produce.  “Conventionally grown crops are regularly and systemically tested for pesticide residue to ensure that what goes from farm to table is safe to eat. The proper use of pesticides, in both organic and conventionally grown crops, is the expertise of farmers who want to put safest and most nutritious foods on our tables.”

Keep in mind that virtually ALL of the vast research showing huge benefits of eating more fruits and vegetables was done on conventional, not organic, produce.  Avoiding fruits and vegetables just because you can’t afford organic is unnecessary and puts you at risk.  It’s all good.  Buy the produce you can afford and will eat (I’m never without canned garbanzos).  Everyone eats more fruit if there are fewer “competing foods” around, like cookies and cake.

Organic or conventional, wash all fresh fruits and veggies.  I took a risk as a kid by eating some dirt and dust on those berries without washing them!

Cut-to-the-Chase

Strong safeguards ensure our food supply is the safest you’ll find anywhere.  Our fruits and vegetables are healthy even if they didn’t come from our own yard.

I work with kids and families.  Their safety and food budgets are important.   I eat conventionally grown produce daily, organic if it’s a good buy.  Eat the ones you enjoy and eat them every day.

PROCESSING THOUGHTS ABOUT “PROCESSED FOOD”

You can’t hear any conversation about food these days without hearing about “processed foods”.  Nutrition experts, medical experts, and those who talk about food a lot all seem to be saying the same thing: processed foods are to be avoided or at least minimized to the greatest extent possible.

It’s easy to join the pile-on but as with everything in life, the processed food issue is not black and white.  Why?

News flash: ALL FOOD IS PROCESSED  

Unless you bite an apple off the tree, it’s probably been processed.  Indeed, the act of washing your fruits and vegetables is a form of processing them.  Peeling, chopping, drying, and cooking are all ways of “processing” food.

Processed food has a spectrum, and a group or researchers based at the University of Sao Paulo, in Brazil developed a system is called “NOVA” that classifies all foods into four groups.  In a nutshell:

  • Group 1: Unprocessed or minimally processed foods.

o   Whole fruits and vegetables, whole or sliced fresh meat and fish,

o   dried fruit and nuts

o   combinations of foods in this category, like granola if made with no added sugars. It also includes enriched white rice.  Fair enough.

  • Group 2: Processed ingredients

o   Iodized salt, vinegar, lard, salted butter, etc.

o   Ingredients used in home and restaurant kitchens to prepare “hand-made” dishes.

  • Group 3: “Processed foods”

o   Canned fish, vegetables, and fruits (including fruit in syrup), cured meats,

o   Cheeses

o   “Unpackaged and freshly made breads.”

o   “Most processed foods have 2 or 3 ingredients.”

o   Beer, cider, wine.

  • Group 4: “Ultra-processed food and drink products.”

o   Yogurt sweetened with sugar or a sugar substitute.

o   “Mass-produced packaged breads”

o   Frozen dinners and pre-prepared, ready-to-heat dishes, savory or sweet.

o   Breakfast cereals (sweetened or not)

o   Candy, desserts, pastries, soda.

o   Infant formula

o   Distilled spirits.

o   Foods with “cosmetic or sensory intensifying additives”,

The authors’ advise avoiding category 4 foods altogether, as they, “damage culture, social life, and the environment.”

WHOA!  Absolutely no scientific evidence for that.

The NOVA system: Science or Ideology?

The system seems based more on politics, philosophy, and ideology than science. Examples:

  • “Common attributes of the Category 4 ultra-processed products are hyper-palatability, sophisticated and attractive packaging, multi-media and other aggressive marketing to children and adolescents, health claims, high profitability, and branding and ownership by transnational corporations.”
  • The “freshly made” white bread loaf from the corner bakery is “processed” but the one that’s “pre-packaged” is “ultra-processed” and should be avoided.
  • Fruit canned in syrup is “processed”, which is OK but you should avoid sweetened yogurt and whole-grain cereal because they’re “ultra-processed”?

The scale of production seems more important than what’s in the food itself. Science doesn’t support this. Large-scale production is the only way you’re going to feed hundreds of millions of people every day.  Foods like packaged whole-grain bread and sweetened yogurt, Greek or conventional, can be a terrific part of a very healthful diet.

This tool will probably be idolized but the developers seem to be speaking to an elitist audience that is disconnected from the realities of the people they need to reach.

Avoid the word “avoid”

As a practicing clinician and registered dietitian for over 30 years, whole grain breakfast cereal is a lot more nutritious than candy.  These foods should be far apart from each other when speaking about nutrition.  It’s also unnecessary to “avoid” any food (unless you’re allergic).  Eat less candy and empty-calorie drinks, yes, but I’d like people to eat more whole-grain cereal and yogurt – sweetened or not.  These are nutrient-rich foods that are underconsumed.  There’s no reason to feel guilty about eating them.

People eat food, not philosophy.  After all, it doesn’t’ become “nutrition” until someone eats it.  My philosophy? I’d argue that the cell phone — or “personal device” – has done more damage to our eating habits and lifestyle than breakfast cereal and sweetened yogurt.

Cut-To-The-Chase Nutrition’s bottom line:

  • Nearly all our food is “processed” in some manner. Processing is fine – it’s what makes many foods edible and safe to eat.
  • There are plenty of healthful, “mass-produced” foods.
  • Down with demonizing food and making people feel guilty, especially when the science isn’t there.
  • “Mass production” also brings us standards that ensure the safety and consistency of our food supply. Food is only nutritious if it’s affordable and accessible.
  • There’s a place for nutrition philosophy, but science, should drive nutrition policy.

IS BUTTER BACK? NO, BUT FULL-FAT DAIRY IS!

Do you shy away from drinking milk and yogurt because you don’t like the low-fat/fat-free stuff but also avoid cheese because of the saturated fat?

Well, have a slice of cheese and read on.  And while you’re at it, scoop some full-fat yogurt on some fruit, too.  Your cardiologist probably won’t cringe, either, and may even give you a high-5.  That’s because several recent studies, both randomized clinical trials, (considered the “gold standard” of research), and observational studies that look at tens of thousands of people and are less rigorous, suggest that full-fat dairy foods — but not butter — may be better for us than we thought.

Dietary guidelines have traditionally advised us to reduce our consumption of saturated fat, and full-fat dairy foods are a significant source of it.  These newer studies are suggesting that saturated fat isn’t all the same, shouldn’t all be under one big umbrella.  Dairy fat, in particular, may behave differently than other saturated fats.

Cheese vs. butter

The fat in these two foods have similar levels of saturated and unsaturated fat.  Makes sense, as they both contain dairy fat from milk.  Butter is simply isolated from the milk, whereas cheese has the fat as well as protein and even a small amount of carbohydrate, depending on how long it was cultured.   Since the fats are of similar type, you could also reason that similar amounts of saturated fat from butter and cheese would behave the same way in the body.

That doesn’t seem to be the case, at least not in this study that reviewed randomized controlled trials, — the gold standard of research – to compare the effects of cheese and butter on blood lipids.  Here’s what they concluded from the studies they reviewed:

  • Compared with butter, cheese reduced both LDL-cholesterol (the bad stuff) by 6.5% and HDL-cholesterol (the good stuff) by 3.9%. Note that the more hazardous LDL dropped much more than the desirable HDL.
  • Cheese intake had no effect on triglycerides.
  • When compared to tofu or reduced-fat cheese, full-fat cheese increased LDL cholesterol.

Foods vs. nutrients

Just as not all saturated fat is the same, it may be a mistake to see all dairy fat as the same, even though it all has the same origin and composition.  Why? Because we’re learning that there’s more to food than just its nutrients.  (You may think, “duh” but in the nutrition world, it’s always been just about nutrients!)

In this 2016 synopsis of several symposia that looked at 131 studies, the research did not show any increased risk for cardiovascular disease from the consumption of full-fat dairy foods.  Moreover, for weight gain, there was actually an inverse relationship with weight gain and obesity risk, meaning that higher consumption of full-fat dairy foods was associated with less obesity and weight gain.

The thought is that when dairy fat exists in foods, it’s bound to a complex matrix that includes milk proteins (chiefly casein and whey) as well as minerals and even bacterial cultures, in the case of cheese and yogurt.  These along with the compounds of digestion, may reduce the absorption of some of the cholesterol and/or saturated fats.

I actually like this type of research because it helps me work with patients who couldn’t care less about the biochemistry of it all, they just want to know how to eat a healthy diet that also tastes good.

Cut-to-the-Chase take-aways:

  • Overall, good news here about cheese and full-fat dairy foods.
  • Keep eating the fatty fish and olive oil!  But it’s OK to replace butter and fattier cuts of meat with cheese and full-fat dairy.
  • IF you like fat-free yogurt and you’re used to 1% or fat-free milk, keep at it!
  • If your diet is short of calcium and vitamin D because you don’t care for low-fat or fat-free diary, and including more full-fat dairy foods would help correct that
  • Spend wisely: Full-fat dairy foods have more calories than lower-fat versions, so be sure you balance calories elsewhere in your diet.

US NEWS’s BEST & WORST DIETS: Get my take & stop building a shelf of diet books

US News started 2017 with their ratings of popular diets.  What stands out?  The sheer quantity!  They rated 38 – count ‘em – 38 diets, and had a panel rate them on many factors, including health, weight loss, and overall.  They also classified them into such categories as best “commercial” diet, most heart-healthy, best diet for diabetics, and on.

What stood out to me? Let’s look at the top 3 diets:

  1. DASH diet: Long-standing winner year after year. It’s a simple concept: lots of fruits and vegetables, low-fat and fat-free dairy every day (some full-fat, too) and cut back on sodium. Developed to lower blood pressure, DASH stands for: Dietary Approaches to Stop Hypertension.
  2. Mediterranean Diet: Focus is on heart health. Like, DASH, the concepts are simple: lots of fruits and vegetables, not much red meat, plenty of fish and daily olive oil and/or nuts like almonds, hazelnuts and walnuts.  Focus here is on olive oil and omega-3 fats.  Another annual favorite.
  3. The MIND Diet: This combines some concepts from the top two diets but gets a bit more specific about certain foods to cut risk for Alzheimer’s disease. Specific fruits and vegetables include green leafy veggies and berries, two foods associated with reduced Alzheimer’s risk.  Fish at least once a week, and low intakes of fatty meat, butter, and empty-calorie desserts and fried foods.

Why I love the top 3 diets

I love that they’re not really diets, just “eating styles”.  There are no absolutes, no rigid “my-way-or-the-highway” rules.  Nothing is prohibited forever, but there are specific to include, but enough variety to allow for favorites within each group.

And there’s solid science behind these eating styles.  The research even indicates a beneficial trajectory.  That is, even if people ate a diet that made some changes, even if not enough to count as a true Mediterranean or DASH diet, but approaching those, they saw reduced risk for developing Alzheimer’s.  You can sustain all three of these eating styles and strong research says you’ll be healthier if you do.

Honorable Mention: #4: The Flexitarian Diet

This diet tied with several others for fourth place but I like it.  It’s healthful, varied and “mostly vegetarian” but recognizes that the world is round.  If you want an occasional burger or taco on this diet, it doesn’t mean you’ve “crossed over to the dark side.” High time.

What about the bottom 3?

  1. Paleo Diet: Despite the popularity, especially among males who want to eat like the hunter-gatherer of 10,000 years ago, this diet ranked last for weight loss, last for fast weight loss, and was considered among the most difficult to follow in modern times. Let’s not forget that 10,000 years ago the life span was short.  The average 40-year-old has been dead a while.
  2. The Dukan Diet: This diet offers an “all-you-can-eat” theme – but only of the allowed foods. It’s big on protein. Really big, and carbs and fats are quite limited.  As with most high-protein, low-carb diets, you’ll lose a lot of weight in the first week or two, but this one got low ratings for being easy to follow and maintain.  Low ratings for healthfulness, too.  The maintenance phase has similarities to other diets: moderation, nothing is off limits except large portions and binges.  Maybe best to start with that?
  3. The Whole30 Diet: Bottom of the heap and I’d agree. Super-restrictive and there are absolutes. Deviations are not allowed.  It only lasts 30 days and is intended so designed to push your body’s re-set button but also to fix dysfunctional relationships with food.  Big claims made here and there’s no research behind this diet (Red flag of junk science – NO science).  I’m against temporary diets.  You’ll be in your body after 30 days but this dietary pattern probably won’t.  And probably shouldn’t.

Edible Rx take-away: Choose one of the top 3 diets that you’re most comfortable with.  Take all of 2017 to gradually move in that direction.

MSG: Could It Mean “Maybe Something Good”?

parmesan-cheese-big-wedge

Most people who would consider themselves nutrition-conscious, and certainly self-respecting foodies, would probably deny that they use or eat monosodium glutamate, or “MSG”.  It has a bad reputation as being dangerous, harmful, you name it. 

 Did you know you’ve been eating glutamate forever?  Here are a few facts about glutamate:

·         It’s the most plentiful amino acid in our bodies.

·         Most of the glutamate in our bodies hangs out in our gut.

·         When chefs and foodies talk about the thing called “umami”, or the “fifth taste” they’re really talking about glutamate.

Glutamate is nothing to fear and there is lots to relish about it.  It’s naturally found in foods like tomatoes, mushrooms, and parmesan cheese, which makes much of the Italian food we love a virtual glutamate bomb – and it’s all OK.

Read more about glutamate in this article I wrote for the MSGdish and The Glutamate Society.  Fortunately, chefs are getting clear about the flavor that a little glutamate adds to foods we love, and using glutamate to bring great flavor to foods in new ways.

Regulate Sugar? Consumers Need to Be Empowered, Not Made Into Victims

 sugar-browncubesonwhitesugarSugar seems to be the new trans fat – it has really bad press.  I’ll grant you, sugar isn’t angel food, but it isn’t devil’s food either.

There are those who would prefer to regulate sugar as though it were tobacco or a drug.  That gets great headlines but as a clinician, I’m a little more practical.  

Sugar isn’t a new food and we consumed it long before there was an obesity crisis.  Indeed, we’re actually eating LESS of it than we did 15 years ago.  

I want my patients to understand food, not fear it.  Read more of my take on the sugar shakedown in my guest editorial in US News.