Drop Dead Healthy

by A. J. Jacobs

  I call up an immunologist named Mary Ruebush, author of Why Dirt Is Good, a rallying cry for the Hygiene Hypothesis.

  “The pendulum has swung,” she tells me. “The first few millennia of human evolution, there was no thought of cleanliness. Then, when we realized there’s a link between cleanliness and health, we went overboard.”

  Like Tierno, she claims superior health. “I don’t remember having a cold or a headache, and I have absolutely no standards of hygiene whatsoever.”

  I suppress my instinct to say that I’m glad this is a phone interview.

  “My standard for hand washing is this: If they look dirty or smell bad, then I wash them,” she says.

  Like Tierno, she has her own scary story about a plane ride.

  “I sat next to an eight-year-old child who was traveling by himself. He proceeded to wipe the seat, the armrest, and the tray table before he would sit down. I was horrified.”

  I tell her about how my son licked ice cream off the sidewalk. “Good for him,” she says. “He is going to be a healthy adult.”

  When I get off the phone, I tell Julie about Ruebush’s thesis. “That’s a wise woman,” Julie says.

  Later that night, when Julie drops a cucumber slice on the floor, she bends down to pick it up and put it on Zane’s plate.

  “Hygiene Hypothesis!” she says gleefully. It’s her new catchphrase.

  I decide to spend a week implementing Tierno’s Germ Battle Plan on myself. I promise Julie I’ll leave her and the kids out of it.

  In his book The Secret Life of Germs, Tierno gives a list of antiseptic-living suggestions, which I’ve transcribed onto my computer. On a Wednesday morning, I begin to implement them. Here’s a small sample:

  • Wipe down the phones and remote controls weekly. (Does wiping them with a moist paper towel really get the germs off? I wish I could boil my electronic equipment.)

  • Soak all produce for five to ten minutes in a solution of water, hydrogen peroxide, and vinegar. (“Hydrogen peroxide?” asks our babysitter as I pour some into a bowl of apples. “Is that safe? I thought that’s what you use to dye hair.” It’s in the book, I tell her.)

  • Wash underwear separately from other clothes to prevent a transfer of fecal residue.

  • Dry laundry in the sun, because the UV radiation kills germs (a clothesline doesn’t work in New York, so I lay my shirts on the outside part of the air conditioner).

  • Remove showerheads and clean them with a wire brush to root out legionella, the cause of Legionnaires’ disease (still have to do this).

  • Vacuum curtains and upholstery regularly.

  • Zap damp sponges in the microwave for one or two minutes.

  • Put hypoallergenic sheets and pillowcases on your bed to keep the dust mites from snacking on your dead skin flakes, because dust mites can cause allergies. (The sheets I bought are kind of slippery, but they make me feel better. Tierno himself takes his germproof sheets with him when he goes to a hotel. I put that on my to-do list.)

  It’s been half a day, and I’m not even close to finishing my list. Germ warfare is a full-time job. Though I do notice something strange. Aside from being busy, I have another feeling: righteousness.

  Maybe it’s my imagination, but now I crave more order in every part of my life. I’m more annoyed when Julie’s late to dinner. I’m more concerned when my son Jasper hangs around with the rambunctious elements in his class.

  Does my punctiliousness have anything to do with my germ obsession? Perhaps not. But the brain is an odd place, and it’s possible that germaphobia has colored my moral view. I read a fascinating New York Times op-ed by two scientists who argue that the more obsessed you are with germs, the more politically conservative you become.

  They conducted an experiment in which they asked subjects about their “moral, social and fiscal” attitudes. “Merely standing near a hand-sanitizing dispenser led people to report more conservative political beliefs,” they write. “Apparently, the slightest signal that germs might be present is enough to shift political attitudes toward the right.”

  The professors—Peter Liberman at Queens College and David Pizarro at Cornell—offer the explanation that early humans often came into contact with other tribes that harbored dangerous germs. So humans evolved to have a feeling of disgust at The Other, which helped keep interactions to a minimum. This sense of disgust is correlated to a conservative, more wary-of-foreigners worldview.

  When I told one of my token conservative friends this theory, he said it sounded absurd. But, he added, at least it gave him license to call liberals dirty.

  Checkup: Month 5

  Weight: 164

  Push-ups till exhaustion: 36

  Dollars spent at GNC on supplements that have iffy scientific support (e.g., açaí berry, resveratrol): $127

  Avocados consumed: 1.5 per day

  The big breaking news for this month is: My gym sessions are altering my body. My chest has a little curve to it, like a very gentle slope on a putting green. When I went running the other day, I could feel my pecs bounce. This experience is new and curiously exhilarating.

  I’m spending an embarrassing amount of time every night studying my torso in the mirror, trying to discern the progress. I have fantasies about running into Vlad the caveman and hearing him say, “I’m sorry for those comments about your chest. Boy, how wrong I was!”

  I now understand why all these reality-show stars walk around with their shirts off. If you spend that much time sculpting your body, you want to display your work of art. Otherwise, it’s like keeping a Brancusi in the garage under a sheet.

  I’ve started to notice other men’s bodies as well. I have biceps envy. I look for their veins in their arms and compare them to mine. Never before have I cared about having visible blood vessels.

  Or maybe I did. Looking back, I don’t think I admitted to myself how much I’ve been self-conscious about my concave chest for years. I pretended not to care. I pretended I was above such concerns. But I also hated changing in the locker room, and would keep my T-shirt on at the beach.

  My new hint of muscle makes me crave more. At the suggestion of my friend Tim Ferriss—author of The 4-Hour Body—I’m taking daily doses of the supplement creatine, an acid found in skeletal muscle.

  At the same time, I’m aware that this obsession with size is ridiculous. There’s only a mild correlation between what we consider healthy looking, and being healthy—especially when it comes to muscle definition. Do the Okinawans in Japan—the longest-lived people on earth—have six-packs abs? I doubt it. Not in the pictures I’ve seen.

  On the food front, I’m still working on my portion control. Before each meal, I say my 80 percent prayer (this is from the Japanese proverb that you should eat until you are only four-fifths full). I’m observing my chewdaism. I’m addicted to these diabolical dried mangoes, so, at the suggestion of social psychologist Sam Sommers from Tufts University, I’ve repackaged them into a bunch of tiny Ziploc bags—one mango slice per bag. It actually works. My mind thinks that it’s getting a full portion, even if the portion is one slice. My mind, in other words, is an idiot.

  But despite my limited victories with portion control, I keep coming back to the fundamental question: What the heck should I put in those portions? What should I eat? Which of America’s ten thousand nutrition experts should I listen to? I pledge to make answering this question my next month’s mission.

  Chapter 6

  The Stomach, Revisited

  The Quest for the Perfect Meal

  A FEW DAYS AGO, I stumbled across what sounded like an interesting perspective: a Colorado-based doctor named Steven Bratman who has discovered what he calls a new eating disorder: “orthorexia nervosa.” He defines “orthorexia” as an unhealthy obsession with healthy foods.

  The idea is that if you are unduly fixated on eating healthfully, you’ll stress yourself out—so much so that the damage from the stress outweighs any potential benefits of the goo
d food. It’s an intriguing idea, so I e-mail Bratman to request an interview.

  He agrees, responding that he has “a number of salty comments.”

  Salty. Interesting choice. He even uses unhealthy foods as adjectives.

  When I talk to him, Dr. Bratman is as full of sodium as promised. He says the obsession with healthy food is “stupid.” Its practitioners are filled with “hot air.” In the end, too much emphasis on your diet is harmful because “you don’t have balance in your life.”

  Once upon a time, Bratman himself had a fetish for healthy food. Back in the seventies, he was an organic farmer and chef at a commune in upstate New York. He spent his days steaming tomatoes and arguing about whether aluminum pots were poisonous. He reached a breaking point when, he says, “a particularly enthusiastic visitor tried to convince me that slicing a vegetable would destroy its energy field.” In frustration, Bratman chased the guy away with a flat Chinese cleaver.

  After his fall from health food grace, he coined the term “orthorexia.” The “ortho” part derives from the Greek for “correct,” and the “rexia” is from the word for “appetite.” Hence orthorexia, the mania for the correct diet. The condition hasn’t yet made it into The Diagnostic and Statistical Manual of Mental Disorders, the bible of psychological illnesses. But it’s gained some fans among therapists and researchers. Bratman wrote a book about the condition called Health Food Junkies.

  The symptoms include:

  • When you stray from healthy food, you’re filled with guilt and self-loathing.

  • You become socially isolated because it’s hard to eat at the same table as less conscientious friends.

  • Healthy eating has become your replacement religion, making you feel virtuous. You regard omnivores with disgust.

  In Bratman’s words, “a day filled with wheatgrass juice, tofu and quinoa biscuits may come to feel as holy as one spent serving the destitute and homeless.”

  So according to Bratman, health food fetishism will hurt me. Perhaps. But even if it’s true, I need some basic instructions on what to eat to be the healthiest person alive. What does he recommend?

  “Don’t get fat and get your vitamins.”

  That’s it? That’s his health advice? I press him for more.

  Bratman resists. The problem is, everyone wants secrets: Selenium will prevent bladder cancer, so eat Brazil nuts! Flavonoids prevent heart disease, so eat pineapple! But the science just isn’t there yet. He tells me all health advice can be boiled down to a single paragraph:

  “Eating fruits and vegetables is vaguely logical. Get sleep. Don’t live in the most polluted parts of the world. Don’t smoke. Don’t do unsafe things like skiing and hang gliding, which are inconceivably more dangerous than eating ‘unhealthy’ foods. Exercise is pretty likely good for you. Don’t drink too much alcohol—one or two drinks a day. And that’s about it.”

  In Bratman’s view, all the hype about antioxidants and glycemic indices is unproven. Nutrition science is barely more evidence-based than phrenology. Or as Bratman puts it, “hardly better than college bullshitting.”

  This stance has not made him friends in the health food community. His website has a section devoted to reader hate mail. One of the milder samples: “Dr. Bratman, you are a moron. Please go to Mickey Dee’s and chow down on a few Big Macs and don’t call me in the morning. I guess Monsanto’s GMO products, high-fructose corn syrup, aspartame, processed sugar and flour are great for us . . . Have a great day and don’t forget to supersize, you idiot.”

  I don’t think Bratman is an idiot. Mind you, I don’t agree with him. His conclusions are far too radical for me. But I believe he provides an important cautionary voice. Because the more I learn, the more I realize we know a lot less about nutrition than the newspaper headlines would have you believe. Food is frustratingly complicated. It resists reductionism. Often, we’ll identify what we think is a secret healthy ingredient—carrots have beta carotene, which is why they prevent cancer. So we’ll give people beta-carotene supplements, only to find out it’s not so simple. Beta-carotene supplements increased the instances of lung cancer among smokers in a large study in Finland.

  Your everyday carrot is filled with so many micronutrients, we don’t yet know how they interact with one another. Michael Pollan, author of The Omnivore’s Dilemma, likes to say, “Nutrition science, in my view, is sort of where surgery was in the year 1650. It’s interesting. . . . But would you really want them operating on you yet?” The best we can do, to paraphrase Pollan, is to eat whole foods, mostly plants, and not too much.

  Ben Goldacre—a British doctor, skeptic, and author of the book Bad Science—is even harsher. He talks about nutritionists’ lack of “intellectual horsepower” and their “crimes” against sensible dietary advice.

  The problem is, it’s hard to conduct randomized placebo-controlled studies on humans and their diets. If you could lock ten thousand people in identical rooms for eighty years and feed half of them nothing but vegan food and feed the other half nothing but steak and eggs, and keep everything else the same, you could have some real data. But unless a Bond villain decides to pursue a doctorate in nutrition, that’s not going to happen.

  Instead, much of our nutrition knowledge comes from two sources. First, animal studies. Which can be enlightening but don’t always translate to humans.

  And second, epidemiological studies. I’m vastly oversimplifying here, but an epidemiological study is when scientists analyze statistics in a population to determine the cause of a disease. It’s a hugely useful tool. Epidemiology helped link tobacco and lung cancer, and cholera and dirty water. But it’s also got limitations, especially when it comes to something as complicated as food and drink. There are hundreds of confounding factors that can throw off the results.

  Consider alcohol. The data show that drinking is healthy because moderate drinkers live longer than teetotalers. But what if it’s not the drinking but the social interaction that goes along with drinking? What if parties and sporting events are healthy, not vodka?

  The science journalist Gary Taubes wrote a great New York Times Magazine story on the problem, and sums it up this way: We often confuse correlation and causation. To cite a famous example: Diabetes rates are much lower in areas where people own passports. Therefore, you might conclude that owning a passport prevents diabetes. Right? Wrong. It’s more likely that passport owners are wealthier, and wealthier people can afford healthier food.

  These complexities make me feel both better and worse. Better because I now understand why nutrition headlines contradict each other every week. (Soy is the secret! Soy is poison!) It’s not always out of stupidity or conspiracy. Sometimes it’s just because it’s so darn complicated.

  But it’s also dispiriting, because at least for now, there are no black-and-white answers.

  The Battle for the Plate

  That said, I can’t give up. I still want to figure out some basic guidelines on what to eat.

  First, let me start with what almost everyone agrees on, not counting Bratman. Study after study suggests we should be eating more whole foods, not processed foods—broccoli instead of french fries. We’ve got way too much sugar in our diet. And to a lesser extent, too much salt. And, as I mentioned before, we eat too much damn food.

  In other words, almost everyone agrees our nation’s typical fried and sugar-laden daily intake is a disaster. My aunt Marti calls it by the delightfully descriptive acronym SAD—Standard American Diet.

  So there’s a lot we all agree on. But there’s also a lot of room for dispute. And man, is there dispute. The nutrition field resembles Congress. There are two warring tribes, and most everyone falls somewhere along the spectrum.

  On the far left side, many advocate for the plant-based diet. On the far right, others argue for the low-carb, high-protein diet.

  Currently, the advocates of the mostly plant diet have the majority. The holy text of radical plant fans is the bestselling 2005 book The China Stud
y by T. Colin Campbell, a nutritional biochemistry professor at Cornell. It’s an impressive book based on a huge twenty-year study of 880 million people in China. The conclusion? Eating animal products causes a large number of health problems, including heart disease, diabetes, breast cancer, macular degeneration, bowel cancer, osteoporosis, and others. The healthiest diet is one with no animal products at all, no beef, no poultry, no eggs, no fish, and no milk. Campbell doesn’t like to call the diet “vegan,” since that carries political tones. But essentially, it’s vegan. So that’s one side.

  The other side is best represented by the aforementioned Gary Taubes, a brilliant journalist who wrote the books Good Calories, Bad Calories and Why We Get Fat. One of his big theses is that the low-fat diet is a sham. It’s based on faulty science. In fact, America adopted the low-fat diet in the 1970s. That’s the exact same era when the obesity epidemic began. The low-fat diet, he argues, has been a giant belly flop.

  The real culprit isn’t fat. It’s carbohydrates—especially refined carbs. Here’s Taubes: “Insulin puts fat in fat cells. That’s what it does. And our insulin levels, for the most part, are determined by the carb-content of our diet—the quantity and quality of the carbohydrates consumed.” The more concentrated the sugar in our carbs, the more dangerous they are.

  Taubes and his camp recommend restricting carbs as much as possible, especially processed carbs, high-glycemic carbs (like bananas), and starchy carbs (like potatoes). Instead, they recommend eating more protein and good fats. They eat a lot of lean beef, eggs, fish, and all sorts of vegetables (spinach and broccoli, for instance). But little grain.

  I’ll tell you where I’ve stood for the last decade or so: On the spectrum, I’ve leaned more toward The China Study side. I’m not vegan. I still eat eggs and salmon. But I don’t eat beef, pork, or lamb. I used to call myself a quasi-vegetarian. Now I prefer the trendier term “flexitarian.”