Common Sense Nutrition For Your Patients
So what IS the right way to eat? Vegan? Paleo? The Zone? Atkins? Pescatarian? Low fat? Dairy-free? The choices are endless and who can figure out the truth amongst all the conflicting headlines and differing research? There are a few missing things that would help us figure this out, including some decent context and common sense, which we've lost somewhere along the line, so let's take a little deeper look rather than relying on individual diets and modern recommendations.
When I lecture on this topic, the first thing I discuss is critical thinking, especially in regards to research. The main concept to understand is this: if an exception exists in regards to a nutrition "rule" (which is really a hypothesis, which we've forgotten), then the "rule" or hypothesis is incorrect. This is key. I'm not talking about individual cases here, I'm talking about if entire cultures existed in healthy contrast to this "rule."
For example, if this maxim "Fat makes you fat" was true, then Pacific cultures like the Vanuatu and Tonga who ate a high fat diet would have been extremely overweight, but that didn't occur until the missionaries brought sugar and refined flour. Or what about the one that says that eating saturated fat causes heart disease? If that one was true, then the French, who eat the most saturated fat in Europe, would have died out long ago. What about "Animal protein causes cancer" or it's corollary, "A plant-based diet prevents cancer"? How, then, do you explain the Inuit, who lived where the permafrost prevented growing any fruits and vegetables? Their diet consisted mainly of fat and protein from sea and land animals, with a little bit of seaweed and lichen thrown in and they had a cancer rate of .01%. Do you see what I mean? I'm not saying that there isn't a grain of truth in most nutrition advice, but it's typically out of context, and if a large exception exists, you simply cannot say with certainty that X causes Y. X might be associated with Y, or correlated in some way, but you cannot make a hard-and-fast rule if large exceptions exist.
Context is also key. We seem to look at life in a narrow slice of, say the last 30-40 years and we think it's always been this way. Like we've always had cars, electricity, antibiotics and macaroni and cheese. We have forgotten how our grandmothers ate, how our forebears ate before her and what actually constitutes a balanced, healthy diet. Context allows us to look at a headline proclaiming that eating eggs is as bad for you as smoking and say, "Hmmm ... doing something that's been perfectly fine since the beginning of mankind all of a sudden is unhealthy? What's wrong with that study?" Turns out there's a lot wrong with that study and nearly all of them with alarmist headlines, so look for these following problems.
Observational Studies: many nutrition studies are done as large, epidemiological studies, which is fine in that is should form a hypothesis upon which actual research is done. Unfortunately, the observation is typically thought of to be "the answer" and then poof! We have a headline. These observations are frequently acquired through questionnaires about food recall — a recent alarmist headline came from a study that did a food recall questionnaire once 18 years ago and then came recently to a conclusion. How were you eating 18 years ago? Has it changed at all since then? Right. A lot of observations are also being done with NHANES (National Health and Nutrition Examination Survey), but recently it was taken to task for its inaccuracy regarding caloric intake because surprise! Nearly everyone was underreporting their caloric intake, with obese males underestimating by 716 calories a day, and obese women by 856 calories. And that was just the calories — who knows what else is incorrect.
Vocabulary: you want to watch for works like "suggests," "is associated with," "is correlated with" or "assumes." I know this seems basic, but we skip right over those words and then assume the evidence is more solid than it is. You would be amazed how often these phrases are used in my graduate nutrition textbooks, which certainly gives me pause in regards to how much we think we know about nutrition.
Mice are not little furry humans. Nor is a study done in a Petri dish applicable to humans, nor is research done on small groups of people. So keep your common sense about you when you read that article and consider checking the actual research.
Most importantly, remember that if an exception exists, then something ELSE is causing the cancer, or heart disease or making us fat.
Common sense nutrition requires opening our minds a bit to consider that possibly, just possibly, we might have been misguided by modern recommendations about food, the term "modern" referring to the last 50-150 years. The traditional Chinese would certainly think so — ask your professors what they ate as children in China and see how different it is from what you grew up eating. I would assert that Americans have the worst nutrition of all the rich nations and this is borne out by our life-expectancy at birth — it's the lowest compared to all of Europe, Japan and Canada, despite us paying twice as much for health care.
People will often say to me that things MUST be better now because we live longer. Antibiotics are much of what has us living longer, as well as ambulances and good emergency cardiac care. If you include the fact that between the years 1500 and 1800, an average of 30 percent of children under the age of five are estimated to have died from diseases like dysentery, scarlet fever, influenza and pneumonia, that greatly lowers the overall mortality but doesn't actually tell you how long someone lived who DID survive an infection. In fact, it's been shown that during the Victorian age of 1840 to 1880, if people survived an infectious disease, they lived just as long as we do now with 10% of the degenerative diseases. So just what did traditional cultures eat to live long and reduce disease?
First of all, across the world, people ate differently — some ate high fat, some high carb, some had lots of fruit, some ate high protein, some ate lots of grains, some ate none. At no point did they ascribe to a fad diet, or eliminate whole food groups (unless they didn't have those foods). They all ate animal products, whether that was fish, seafood or land animals, eggs and dairy, even the previously-thought-of vegetarian Hindus in India, who were in fact found to be eating insects ground into their grains. They all ate between 30% and 80% of their total caloric intake in fats, with the majority of that being saturated fats (only 4% of the diet was liquid poly-unsaturated fats like fish oil, seed, nut and grain oils). Seeds, nuts and grains were soaked, sprouted or fermented to neutralize that anti-nutrients like phytic acid and lectins. They all had lacto-fermented foods to provide probiotics, whether that was vegetables, dairy, beverages or condiments. They all cooked some of their food but also had some of their food raw, including some of the animal products, whether that was raw seafood, raw dairy, raw eggs or raw meat. They didn't avoid salt. They ate the whole animal, including the organs, and used the bones for bone broth. And, most importantly, they DIDN'T eat refined sugar or high fructose corn syrup; white flour; canned foods; pasteurized, homogenized, skim or low fat milk; refined or hydrogenated vegetable oils; protein powders; artificial vitamins; or toxic additives and colorings.
It's estimated that 70% of the U.S. diet consists of processed food. This includes the organic, gluten-free crackers you buy, and the whole grain flaky cereal your child craves. It is not limited to "regular" grocery stores, but includes every single retail food store that exists, including the whole food, "healthy" ones. It was the processing of food that undid the Victorians, when meat started to be canned, sugar shipped, and wheat brought over from North America. And it is undoing us today.
Processed food means just about everything in a bag, box or can and while we might not make our own butter, you might want to see how long an ingredient list is on some of your "healthier" foods, like your coconut milk, or that "naturally buttery spread". Just think for a moment. How DO you get oil out of a non-oily soybean? With heavy processing. Those flakes in cereal? Extrusion makes that happen, meaning the ingredients are ground up, injected with steam, and passed through an extruder, with intense heat and pressure. And heat, if you remember, can damage proteins, so draw your own conclusions about the relative healthiness of those products. Low fat milk is processed, since it certainly didn't come out of the cow that way! How about agave nectar? The root isn't used in its natural form because it's not sweet enough, so we process it to concentrate its fructose, make it into a syrup, and think it's a healthier alternative to sugar. It's not. Then there's GMO foods, factory farming, artificial flavoring masquerading as "natural flavoring" ... there are a million examples of unnatural processing all around you as you stand in a food store.
And then there's sugar. It is the introduction of sugar that made those healthy traditional cultures, with their variations of high carbs or high fat, or high protein, ultimately become overweight, get heart disease, cancer and the like. You simply cannot limit sugar enough. The current recommendations from the USDA speak to eating "sugar in moderation" (the sugar lobby is strong) but what exactly is "moderation" when we've gone from eating four pounds of sugar a year in the 1700's to 130-150 pounds a year currently? Just because it's natural, isn't a free ride either — we used to have to fight bees for honey, but now that we can buy large amounts in the store, it can be abused as well.
I teach my patients processed food awareness by having them look at the food and figure out how far away from its original form is this food. How bastardized has it become? How many ingredients does it have? Would you have those ingredients at home? Most importantly, would your grandmother recognize this food?
In talking to people about how to have some common sense about food, I tell them moderation in everything (except sugar). This means not too much, not too little of everything. You might have to find out what works for you specifically, since some people can metabolize carbs better than others, or do better with higher fat, or feel better with a bit less protein and more veggies, or need to leave out dairy because they have an intolerance. You'll have to find your own way and what works for you. The big point here though, is that common sense dictates that you cannot leave out whole food groups if you want to be healthy. You will not be healthy if you eat low fat. You risk carnitine, B12, zinc and iron deficiency if you don't eat meat. If you leave out eggs, or you eat too few vegetables, or any other natural food, you risk malnutrition if you don't replace those foods with some nutrient-dense equivalent. Overall, common sense eating looks is this:
- Eat a plant-based diet, in that you can't eat enough vegetables (and fruits are not a substitute).
- Eat some animal-based protein, which includes eggs and dairy, to prevent deficiencies from nutrients found only in animal products.
- Eat more saturated fats like coconut oil and butter and don't have too many liquid fats.
- If you must have grains, restrict the amount you have in terms of frequency or serving size, and prepare them properly by soaking, sprouting or fermenting.
That's it. No numbers, no counting, no complications. Vegetables, protein and fats, in whatever ratio works for you, should be the majority of your diet and eating frequently enough and including enough fat will reduce the sugar cravings most people struggle with. Get your palate used to a reduction in sweetness, by remembering fruit was a rare dessert for centuries. No fake foods and as little processing as possible. Use stevia or xylitol or small amounts of honey as a sweetener if you need to. Add in fermented foods for the natural probiotics. Moderate alcohol is fine for those who want it. That concern that alcohol intake increases chances of breast cancer? Turns out the research saw that association only in folate-deficient women. So eat more veggies!
- "Egg yolk consumption almost as bad as smoking when it comes to atherosclerosis, study suggests" Science Daily, August 2012. Retrieved 3/15/14.
- Archer, Edward, Gregory A. Hand, and Steven N. Blair. "Validity of US Nutritional Surveillance: National Health and Nutrition Examination Survey Caloric Energy Intake Data, 1971–2010." PloS one 8.10 (2013): e76632.
- Institute of Medicine of the National Academies, Report 2013. U.S. Health in International Perspective: Shorter Lives, Poorer Health
- Clayton, Paul, and Judith Rowbotham. "How the mid-Victorians worked, ate and died." International journal of environmental research and public health 6.3 (2009): 1235-1253.
- Chanarin, I., et al. "Megaloblastic anaemia in a vegetarian Hindu community." The Lancet 326.8465 (1985): 1168-1172.
- Warner, Melanie. "Pandora's Lunchbox". Simon and Schuster, New York. 2013. P. 221
- Zhang, Shumin M., et al. "Plasma folate, vitamin B6, vitamin B12, homocysteine, and risk of breast cancer." Journal of the National Cancer Institute 95.5 (2003): 373-380.