It is not an exaggeration to say that my beliefs are challenged a greater number of times each week I am at college than throughout my entire preceding childhood and adolescence combined. It can be aggravating and tiring and confusing, but I am profoundly grateful to be fortunate enough to get the kind of education where I am constantly forced to think critically about what I hold to be true both inside and outside the classroom. I never would have started this blog had I not been open-minded to perspectives on the food system that were different from mine.
This past weekend, I was yet again confronted with a view of the food system and public health that I found troubling. This post is my way of trying to reconcile my cognitive dissonance about it, I suppose.
Sunday evening, I went to a charity gala for global public health hosted by some student groups on campus. One of the speakers is a very prominent nutrition researcher at my university. He is also a high-ranking member of a national professional organization of nutrition scientists. I knew of him because he had been a guest lecturer in a few of my classes before, but I had only experienced him teaching about nutrition on a molecular level. I was looking forward to his talk at the gala because the topic was to be about the role of the food supply in public health (a.k.a. my raison d’être).
To frame his presentation, he made a very important distinction between the philosophy of medicine and the philosophy of public health practice: while physicians promise to do no harm, public health advocates aim to minimize risk. From there, he raised a question that is extremely relevant to my interests, and that is: should we expect the food supply to prevent disease? (I bet you can guess my answer to that one.)
To attempt to answer this question, he outlined the trajectory of one of the greatest public health success stories in history—prevention of birth defects by fortifying the food supply with folate. This professor’s area of expertise is folate metabolism and its role in gene expression in healthy and disease states. He explained that there is a significant minority of the population who are extremely vulnerable to a folate deficiency in utero, and need to consume much higher levels of folate (a B vitamin) than the rest of the population in order to prevent paralyzing neural tube defects. By requiring enriched grains (found in white bread, cereal, crackers, etc.) to be fortified with folate, governments are now able to drastically reduce such horrendous outcomes.
This all sounds great, right? And it was, until he essentially said pregnant women could put their children at risk by choosing whole grains (which are not enriched with folate). Many of my readers who know how big a proponent I am of a minimally processed, whole food diet will not be surprised that I found this extremely unsettling. In my mind, I was convinced that the benefits of eating whole grains far outweigh missing out on the added folate in refined grains, especially because I was sure you could get enough folate by eating plenty of dark, leafy greens, and a variety of other whole foods.
I approached the speaker afterwards and ask him if fortification would even be necessary if society shifted away from highly processed foods to more whole foods—after all, the reason food manufacturers started adding vitamins and minerals to white flour in the first place was because of the nutrients lost during processing. To my chagrin, he insisted that for the segment of the population that is vulnerable to folate deficiency in utero, their mothers could eat spinach all day long and never absorb enough folate to prevent neural tube defects; only fortification or supplementation would be sufficient. I have no doubt he’s right; he’s one of the foremost experts on folate and health. He then expressed regret that although there are a lot of benefits to eating whole grains, whole grain flours are not traditionally fortified with folate, because it would interfere with the “natural” image (which is an entirely different conversation).
The whole experience really made me confront the idea that solving our nutritional crisis is not as simple as changing the food environment to favor whole foods. I still firmly believe, of course, that to minimize risk, especially in terms of chronic illness that develops over a lifetime, that favoring whole foods is the way to go. However, favoring whole foods does not mean eliminating processed foods. I have never tried to claim that all forms of food processing are bad. Hell, I would never be able enjoy whole grains at all if it weren’t for processing, let alone bread or pasta. Processes like canning, drying, and freezing are indispensable forms of food preservation. Cooking, grinding, and juicing can make foods more palatable and digestible and make nutrients more absorbable. Pasteurization keeps certain foods safe from contamination by pathogens. Although we should consume sweeteners and salt in moderation, I would never suggest we should get rid of these highly processed additives completely. And, as I’ve come to accept, fortification is sometimes to best way to prevent serious micronutrient deficiencies.
Obviously I did not agree with this particular researcher on everything. But he’s been studying nutrition a lot longer and more in depth than I have, and his commitment to scientific integrity was clear from our ensuing conversation. Truth be told, that’s all I could expect from someone trying to convince me of his point of view. Here’s hoping my peers and my superiors keep pushing me out of my comfort zone.