The more I work in the nutrition field, the more I realize how critical FOOD has become. And yet, it is essentially ignored by most nutritionist and health practioners. Well not food exactly, but the quality of food.
In development circles, there is much talk about improving agriculture around the world. How are we going to feed potentially 9 billion people and do it in a sustainable way that treads lightly on the earth? Better yet, how are we going to not only “feed” everyone, but feed everyone WELL?
Another example. Many nutritionists working very hard to end undernutrition are looking for some magic bullets – a vitamin A supplement (one of many nutrients). Zinc to treat diarrhea (again, one of many nutrients). Therapeutic foods to treat malnourished children (sustainable? Cost effective? Not sure…). These are all important, but when will we bring food back into the equation as part of the solution? Oh yes, I know, it hasn’t worked in the past, and we have to solve the issue now. I agree with the “now” part but having not worked, is simply not true. But I digress. Let’s get back to the quality FOOD.
We need to be thinking much more clearly on how we can get the right high quality foods into the mouths of many. And this isn’t just a concern for the developing world but for the rich countries as well. We have massive malnutrition – both under and overnutrition – all over the world, and there is no end in sight. But what are the right foods? What should people be eating in Dakar, Buenos Aires, Detroit, as well as rural places like Cicely Alaska (aka Northern Exposure) and Gumulira Malawi? Should they be taking a fish oil capsule for their omega 3s, eating blueberries because Shape magazine classified it as a super food and wash it all down with red wine? You know those French and their paradox…
Much of the research done in wealthy nations has focused on nutritional elements of foods, understanding food as “nutrients”. Pollan and others have termed this the “reductionist” approach to nutrition – breaking down a food, understanding its chemical composition, classifying the nutrients within and figuring out which ones can cure cancer, reduce heart disease and make you look younger. Often certain foods, based on having a specific nutrient like high levels of antioxidants, or vitamin C or omega 3s become “super foods”. You’ve seen the lists. Other foods have become “bad” for you like eggs for their cholesterol, steak for their saturated fat and the list goes on. What has happened as a result is mass confusion on the part of consumers. Scrinis describes this in his piece in Gastronomica as “nutritionism.”
We do know that diets cannot be broken down into specific nutrient or healthful components, in which the data is basically all over the place. Diets are made up of different foods, processed and cooked and eaten in complex sociocultural ways. This is what we call diversity! Waage and others wrote that no single known component nutrient explains the observed beneficial health effects of consuming certain diets such as diets high in vegetable and fruits. A recent article in JAMA showed that “the effects of foods likely reflect complex synergistic contributions from and interactions among food structure, preparation methods, carbohydrate quality, protein type, micronutrients and phytochemicals. Healthy eating patterns share many characteristics emphasizing whole or minimally processed foods and vegetable oils, with few highly processed foods.”
Maybe Pollan was right when he said to “eat food. not too much. mostly plants.” We know that specific whole foods and diets have been shown to be healthful ala the Mediterranean diet. It isn’t just the olive oil. It is the fish, the legumes, the yogurt, the red wine, the vegetables, the citrus, the LIFESTYLE…But as Mozaffarian and Ludwig wrote, “the nutrient -based (aka reductionist) approach may foster dietary practices that defy common sense.”
So what to do? I think there needs to be a paradigm shift in thinking. We need to be thinking of food based approaches and food based recommendations. The biological and biochemical benefits and risks to specific nutrients should be noted, as much research and efforts have gone into understanding nutritional deficiencies (scurvy, vitamin C…) but we need to start giving food based dietary patterns, food systems and quality food their time in the spotlight.