For the purposes of this book, I’ve created two simple tools to help you integrate everything I’ve learned into your own daily life:
1. a Traffic Light system to quickly identify the healthiest options, and
2. a Daily Dozen checklist that will help you incorporate the foods that I consider essential to the optimal diet. (Check out the free app on iPhone and Android.)
So which foods are good for you, and which are bad?
This sounds like a simple enough question. In truth, I’ve found it difficult to answer. Whenever I’m asked at a lecture whether a certain food is healthy or not, I have to invariably reply, “Compared to what?” For example, are eggs healthy? Compared to oatmeal, definitely not. But compared to the sausage links next to them on the breakfast platter? Yes.
What about white potatoes? They’re vegetables, so they must be healthy, right? Someone asked me this a few years ago after a group of Harvard University researchers raised concerns about baked and mashed potatoes.1 So are they healthy? Compared to french fries, yes. Compared to a baked or mashed sweet potato? No, they’re not.
I realize these may not be satisfying answers for people who just want to know whether or not to eat the darned potato, but the only way to answer the question meaningfully is to ask what your other options are. If you’re in a fast-food restaurant, for example, a baked potato may very well be your healthiest option.
Compared to what? is not just a Socratic learning exercise I have practiced with my patients and students. Eating is essentially a zero-sum game: When you choose to eat one thing, you are generally choosing not to eat another. Sure, you could just go hungry, but eventually your body tends to balance things out by eating more later. So anything we choose to eat has an opportunity cost.
Every time you put something in your mouth, it’s a lost opportunity to put something even healthier in there. Think of it as having £2,000 in your daily caloric bank. How do you want to spend it? For the same number of calories, you can eat one Big Mac, one hundred strawberries, or a five-gallon bucket of salad. Of course, these three options don’t exactly fill the same culinary niche—if you want a burger, you want a burger, and I don’t expect kilos of strawberries to make it on the Pound Menu anytime soon—but this is an illustration of how mountainous a nutritional bang you can get for the same caloric buck.
The opportunity costs exacted are not only the nutrients you could otherwise be getting but the unhealthy components you could otherwise be avoiding. After all, when was the last time you had a friend diagnosed with kwashiorkor, scurvy, or pellagra? These are some of the traditional nutrient-deficiency diseases upon which the foundation of the field of nutrition was built. To this day, the nutrition and dietetic professions remain focused on what nutrients we may be lacking, but most of our chronic diseases may have more to do with what we’re getting too much of. Know anyone suffering from obesity, heart disease, type 2 diabetes, or high blood pressure?
Isn’t It Expensive to Eat Healthfully?
Researchers at Harvard University compared the cost and healthfulness of various foods across the country, hunting for the best bargains. They found that in terms of nutritional value for money, people should buy more nuts, soya foods, beans, and whole grains, and less meat and dairy. They concluded: “The purchase of plant-based foods may offer the best investment for dietary health.”2
Less healthy foods only beat out healthier foods on a cost-per-calorie basis, which is a way we measured food cost back in the nineteenth century. Back then, the emphasis was on cheap calories, no matter how you got them. So while beans and sugar both cost the same at that time (three pence a pound), the U.S. Department of Agriculture promoted sugar as more cost effective for pure “fuel value.”3
The USDA can be excused for discounting the nutritional difference between beans and pure sugar. After all, vitamins hadn’t even been discovered yet. Nowadays, we know better and can compare the cost of foods based on their nutritional content. An average serving of vegetables may cost roughly four times more than the average serving of junk food, but those veggies have been calculated to average twenty-four times more nutrition. So on a cost-per-nutrition basis, vegetables offer six times more nutrition per pound compared to highly processed foods. Meat costs about three times more than vegetables yet yields sixteen times less nutrition based on an aggregate of nutrients.4 Because meat is less nutritious and costs more, vegetables net you forty-eight times more nutrition per pound than meat.
If your intent is to shovel as many calories as possible into your mouth for the least amount of money, then healthier foods lose out, but if you want to shovel the most nutrition into your mouth as cheaply as possible, look no further than the produce aisle. Spending just thirty pence more per day on fruits and vegetables may buy you a 10 percent drop in mortality.5 Now that’s a bargain! Imagine if there were a pill that could reduce your chance of dying by 10 percent over the next decade and only had good side effects. How much do you think the drug company would charge? Probably more than thirty pence.
Dining by Traffic Light
The U.S. government’s official Dietary Guidelines for Americans has (as of this writing) a chapter “Food Components to Reduce,” which specifically lists added sugars, calories, cholesterol, saturated fat, sodium, and trans fat.6 At the same time, there are nine so-called shortfall nutrients, of which at least a quarter of the American population isn’t reaching an adequate intake. These are fibre; the minerals calcium, magnesium, and potassium; and vitamins A, C, D, E, and K.7 But you don’t eat food “components.” You eat food. There’s no magnesium aisle in the supermarket. So which foods tend to have the most of the good stuff and the least of the bad? I’ve simplified it into a traffic light illustration (see figure 5).
Just as on the road, green means go, yellow means caution, and red means stop. (In this case, stop and think before you put it into your mouth.) Ideally, green-light foods should be maximized, yellow-light ones minimized, and red-light foods avoided.
Figure 5
Is avoid too strong a word? After all, the Dietary Guidelines for Americans merely encourage you to “moderate” your intake of unhealthy foods.8 For example: “Eat fewer . . . sweets.”9 From a health standpoint, though, shouldn’t you generally try to avoid sweets? Public health authorities don’t just advise you to smoke less tobacco. They tell you to quit. They know only a small fraction of smokers will actually heed this advice, but it’s the job of public health authorities to say what’s best and let people make up their own minds.
That’s why I appreciate the American Institute for Cancer Research (AICR) recommendations. Not beholden to the USDA, the AICR simply lays out the science. When it comes to the worst of the worst, the institute doesn’t pull any punches. Instead of the Dietary Guidelines for Americans’ advice to “Consume fewer . . . sodas,”10 the AICR cancer prevention guidelines advise: “Avoid sugary drinks.” Similarly, the AICR doesn’t just say to cut back on bacon, ham, hot dogs, sausage, and luncheon meats. The cancer guidelines tell you to “avoid processed meat.” Period. Why? Because “data do not show any level of intake that can confidently be shown not to be associated with risk.”11
The healthiest diet is one that maximizes the intake of whole plant foods and minimizes the intake of animal-based foods and processed junk. Simply put, eat more green-light foods. Eat fewer yellow-light foods. And, especially, eat even fewer red-light foods. Just like running red lights in the real world, you may be able to get away with it once in a while, but I wouldn’t recommend making a habit out of it.
Given this, what we’ve seen in the previous chapters makes a lot of sense. Unprocessed plant foods tend to have more of the protective nutrients that Americans are lacking and fewer disease-promoting factors. No wonder the eating habit apparently best able to control our epidemics of dietary disease is a whole-food, plant-based diet. After all, food is a package deal.
This is one of the most important concepts in all of nutrition. Yes, there is calcium in
cheese, protein in pork, and iron in beef, but what about all the baggage that comes along with these nutrients—the dose of dairy hormones, the lard, the saturated fat? As much as Burger King proclaims you can “Have It Your Way,” you can’t go up to the counter and ask for a burger, hold the saturated fat and cholesterol. Food is, indeed, a package deal.
Dairy is the number-one source of calcium in the United States, but it’s also the number-one source of saturated fat. What kind of “baggage” do you get along with the calcium in green, leafy vegetables? Fibre, folate, iron, and antioxidants—some of the very nutrients lacking in milk. By getting most of your nutrition from whole plant foods, you get a bonus instead of baggage.
When the National Pork Board promotes ham as an “excellent source of protein,”12 I can’t help but think of the famous quote from a McDonald’s senior vice president for marketing who, under oath in a court of law, described Coca-Cola as nutritious because it is “providing water.”13
Why Don’t the Dietary Guidelines Just Say No?
The green-light message shines brightly in pronouncements telling you to “eat more fruits and vegetables,” but the yellow and red lights can be dim and cloudy thanks to politics. In other words, the guidelines are clear when there is eat-more messaging (“Eat more fresh produce”), but eat-less messaging is obscured into biochemical components (“Eat less saturated and trans fatty acids”). National health authorities rarely just say to “eat less meat and dairy.” That’s why my green-light message will sound familiar to you (“Oh, ‘eat fruits and veggies’—I’ve heard that before”) but the yellow- and red-light messages may sound controversial (“What? Minimize meat? Really?”).
Part of the USDA’s mission is “expanding markets for agricultural products.”14 At the same time, the federal agency is tasked with protecting public health by helping to develop the Dietary Guidelines for Americans. That’s why, when those two directives are in sync, their eat-more language is clear: “Increase fruit intake.” “Increase vegetable intake.”15 But when their dual mandates are in conflict—when “improving nutrition and health” is at odds with promoting “agriculture production”16—the eat-less messaging of the Dietary Guidelines gets repackaged and ends up referring to biochemical components: “Reduce intake of solid fats (major sources of saturated and trans fatty acids).”
What’s the average consumer supposed to do with that obscure little nugget?
When the Guidelines tell you to eat less added sugar, calories, cholesterol, saturated fat, sodium, and trans fat, that’s code for eat less junk food, less meat, less dairy, fewer eggs, and fewer processed foods. But they can’t actually say that. When they did in the past, all heck broke loose. For example, when a USDA employee newsletter even suggested trying a meat-free lunch once a week as part of Johns Hopkins University’s School of Public Health “Meatless Mondays” initiative,17 the resulting political firestorm from the meat industry led the USDA to retract the advice just hours later.18 “As a result of these conflicts [of interest],” concluded an analysis in the Food and Drug Law Journal, “the Guidelines sometimes favor the interests of the food and drug industries over the public’s interest in accurate and impartial dietary advice.”19
This reminds me of the landmark report on trans fat from the National Academy of Sciences’ Institute of Medicine, one of our most prestigious institutions.20 They concluded that no amount of trans fat is safe “because any incremental increase in trans fatty acid intake increases C[oronary] H[eart] D[isease] risk.”21 Since trans fats are found naturally in meat and dairy products,22 this placed them in a quandary: “Because trans fats are unavoidable in ordinary, non-vegan diets, consuming 0 percent of energy would require significant changes in patterns of dietary intake.”23
So if trans fats are found in meat and dairy and the only safe intake of trans fats is zero, that means the Institute of Medicine went on to encourage everyone to start eating a plant-based diet, right? No, they did not. The director of Harvard’s Cardiovascular Epidemiology Program famously explained why: “We can’t tell people to stop eating all meat and all dairy products,” he said. “Well, we could tell people to become vegetarians,” he added. “If we were truly basing this only on science, we would, but it is a bit extreme.”24
We certainly wouldn’t want scientists to base anything on science!
How SAD Is the Standard American Diet?
As cynical as I’ve become about diet and nutrition in this country, I was still surprised by a 2010 report from the National Cancer Institute on the status of the American diet. For example, three out of four Americans don’t eat a single piece of fruit in a given day, and nearly nine out of ten don’t reach the minimum recommended daily intake of vegetables. On a weekly basis, 96 percent of Americans don’t reach the minimum for greens or beans (three servings a week for adults), 98 percent don’t reach the minimum for orange vegetables (two servings a week), and 99 percent don’t reach the minimum for whole grains (about three to four ounces a day).25
Then there was the junk food. The federal guidelines were so lax that up to 25 percent of your diet could be made up of “discretionary calories,” meaning junk. A quarter of your calories could come from candyfloss washed down with Mountain Dew, and you’d still be within the guidelines. Yet we failed. Astoundingly, 95 percent of Americans exceeded their discretionary calorie allowance. Only one in a thousand American children between the ages of two and eight made the cutoff, consuming less than the equivalent of about a dozen spoonfuls of sugar a day.26
And we wonder why there is an obesity epidemic?
“In conclusion,” the researchers wrote, “nearly the entire U.S. population consumes a diet that is not on par with recommendations. These findings add another piece to the rather disturbing picture that is emerging of a nation’s diet in crisis.”27
Producers of unhealthy commodities aren’t out to make you sick. They’re just trying to make a buck. Coca-Cola’s profit margin, for example, is about one quarter of the drink’s retail price, making soft-drink production, alongside tobacco, among the most profitable industries.28 What’s harder to understand is why the public health community isn’t doing more about it.
“When the history of the world’s attempt to address obesity is written,” wrote the head of Yale University’s Rudd Center for Food Policy & Obesity, “the greatest failure may be collaboration with and appeasement of the food industry.”29 For instance, Susan G. Komen, a leading U.S. breast cancer charity, linked up with fast-food giant KFC to sell pink buckets of fried chicken.30
Save the Children used to be a leader in the push for taxes on fizzy drinks to offset some of the costs of childhood obesity. Then the organization did an abrupt 180-degree turn, withdrawing its support, saying that such campaigns no longer “fit with the way that Save the Children works.” Perhaps it is only a coincidence that it was seeking a grant from Coca-Cola and had already accepted a $5 million grant from Pepsi.31
Even though our eating habits are now killing more Americans than our smoking habits,32 I often hear the refrain in public health circles that we have to work with, rather than against, these companies, because unlike with tobacco, we don’t have to smoke, but we do have to eat.33 Well, yes, we need to breathe—but we don’t need to breathe smoke. And yes, we need to eat, but we don’t need to eat junk.
How I Define “Processed”
My Traffic Light model stresses two important general concepts: Plant foods, with their greater protective nutritional factors and fewer disease-promoting ones, are healthier than animal foods, and unprocessed foods are healthier than processed foods. Is that always true? No. Am I saying that all plant foods are better than all animal foods? No. In fact, one of the worst items on shop shelves is partially hydrogenated vegetable shortening—a product that has vegetable right in its name! Even some unprocessed plants—such as blue-green algae—can be toxic.34 Anyone who’s had a bad case of poison ivy knows plants don’t always like to be messed with. In general, though, choose
plant foods over animal foods, and unprocessed over processed. Michael Pollan, bestselling author of The Omnivore’s Dilemma, has said, “If it came from a plant, eat it. If it was made in a plant, don’t.”35
What do I mean by processed? The classic example is the milling of grains from whole wheat to white flour. Isn’t it ironic that these are called “refined” grains, a word meaning improved or made more elegant? The elegance was not felt by the millions who died in the nineteenth century from beriberi, a vitamin B-deficiency disease that resulted from polishing rice from brown to white.36 (White rice is now fortified with vitamins to compensate for the “refinement.”) A Nobel Prize was awarded for the discovery of the cause of beriberi and its cure—rice bran, the brown part of rice that was removed. Beriberi can cause damage to the heart muscle, resulting in death from heart failure. Surely such a thing could never happen in modern times—an epidemic of heart disease that could be prevented and cured with a change in diet? Come on. (Please reread chapter 1.)
Sometimes, however, processing can make foods healthier. For example, tomato juice appears to be the one common juice that may actually be healthier than the whole fruit. The processing of tomato products boosts the availability of the antioxidant red pigment lycopene by as much as fivefold.37 Similarly, the removal of fat from cacao beans to make cocoa powder improves the nutritional profile, because cocoa butter is one of the rare saturated plant fats (along with coconut and palm kernel oils) that can raise your cholesterol.38
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