The Trouble With Food Dogma

More and more, it seems like the food controversies I read and write about come down to dogma. What do I mean by that? When it comes to food, people—or at least the people who are vocal in the media—seem to like to get attached to an ideology. They become so convinced of its righteousness that any information that opposes it has to be wrong, in their minds. I’m certainly no exception to this phenomenon. I’ve pled guilty before to confirmation bias (tending to consume media and information that confirms what I already believe) and I stand by that. I think it’s easy for people to see things as black and white; people are uncomfortable with gray areas, especially when it comes to issues as critical as public health and environmental conservation.

It has often been the case throughout history that radical thinkers lead the way to broad-scale paradigm shifts, people who stand by their beliefs no matter what. One problem with dogmatic thinking, particularly when it comes to food, health, sustainability, and inequality, is that science doesn’t care about dogma. Science is skeptical. Science is disagreement. It’s about looking at all of the evidence available and coming to a consensus, but not necessarily a permanent one. It’s kind of a silly example, but there was a time when the brightest minds in the world believed that the earth was flat—that was their conclusion based on the best evidence available at the time. Fortunately, enough evidence accumulated that contradicted the flat-earth theory that the scientific consensus changed. Getting attached to an ideology has the potential to inhibit scientific progress because it closes your mind to new evidence that might contradict your ideology. That being said, it is never the case that one study or a handful of studies should be able to overturn a theory based on evidence from hundreds of studies. Unfortunately, the media often flips that assertion right on its head, especially when it comes to nutrition science (for more on science in the media, definitely watch this video from John Oliver’s Last Week Tonight).

I thought I would talk about a few of the clashing ideologies I often confront in my day-to-day business, and why it’s bad that we get so polarized about our food.

One that’s obviously really personal to me is veganism versus the typical omnivorous American diet. I’ve explained this many times before on my blog, but it is clear to me from the evidence I’ve encountered and the experts I trust that the most health-promoting diet is one that maximizes minimally processed plant foods and minimizes highly processed foods and animal products. I also believe that reducing consumption of animal products will be better for the environment. Transitioning to a 100% plant-based diet was the best way for me to live according to my values, but I wouldn’t necessarily recommend it for everyone. And even if I did think that 100% plant-based was the only way to go, I don’t think spreading that message would be as effective as just encouraging any change in the right direction. Public health and environmental authorities should certainly give people information about what’s best based on all of the evidence, but an all-or-nothing mindset can be very alienating for a lot of people and not necessarily accurate. If you saw my post interviewing my friend the aspiring dairy veterinarian, she opened my mind to the idea that cows offset a lot of our own detrimental food waste by consuming parts of foods that we cannot digest and turning them into digestible food. Of course, far more animals are produced than can just live off our waste, among many other concerns I have about the scale of global animal agriculture. But there certainly is a valid argument for maintaining some degree of animal agriculture, even from a nutritional standpoint. It is disheartening to me that people think they can’t make a positive change in their eating habits just because they don’t want to be totally vegan. Yeah, I know, you could never give up x (cheeseburgers, pizza, steak, you name it), but I’m not asking you to. Try eating it less often than you do now. Try eating one more serving of vegetables per day. Even that much of a change will make a significantly positive impact on your long-term health. Veganism often equates to dogma, but the benefits of plant strong diet are based on science.

Similarly, there is a certain segment of the public that gets very dogmatic about food processing, claiming that all additives and methods of processing are harmful to health. I would never say that all forms of food processing are inherently bad, only that it happens to be the case that a lot of highly processed foods encourage overeating, are low in critical nutrients, and tend to displace more nutritious foods in one’s diet. There are certain foods whose nutrients are more bioavailable when processed, like cooking tomatoes or fermenting grains. Without modern processing and preservation methods we could not have nearly as much variety and certainty in our food supply as we do. And like I wrote about in this post, fortification certainly has its merits. I can comfortably say, though, that we’ve gone a bit overboard with certain forms of processing, like, say, adding sugar to every flipping packaged food on the shelf. People get pretty dogmatic about those additives too, all those scary sound chemicals on the ingredient lists of some packaged foods. My feeling about that is that it’s not doing anyone too much good to demonize, say, aspartame for all of our problems, because the reality is way more complex than that. Usually you have to reach much higher levels of consumption than what’s typically present in foods to show any harm in experimental settings. But I’d like to emphasize that what is evident is that a heavily whole food diet, which is universally associated with good health, mostly avoids all of the additives that are associated with risk.

Another really polarizing controversy is conventional versus organic farming. There are some organic advocates who won’t settle for anything less than a worldwide conversion to organic farming. There are also plenty of advocates that stress that chemical and genetically engineered farming is the only way to yield enough to be able to feed the world. The way I see it, again, is that it doesn’t have to be all or nothing to change for the better, and that in fact, our food system would probably work best with a combination of conventional and organic farming methods. We all have to be willing to sacrifice our ideology and be able to be critical of both methods. For that matter, the farms that fall under each broad category of “conventional” and “organic” are not homogenous. Although in general I think we would be better off if a lot more of our food was farmed organically, I’m sure there are farms that would not qualify as organic that are using much more sustainable and safe practices than some technically organic farms. And if we should be transitioning more farming to organic practices, the all-or-nothing regulatory system for organic farming is not helping matters. It takes a lot of time and resources for a conventional farm to transition to completely organic standards to be certified by the USDA, and there is no benefit or price premium for farms that are in that in between stage, so the system can act as a disincentive to make that transition.

The larger issue here may not be that people hold these dogmas and biases, but that their ideologies prevent them from engaging in dialogue with people who disagree with them. It is very often the case that the truth about what’s best for health, animal welfare, or the planet lies somewhere in between the extremes of belief that are visible in the media. It’s especially apparent to me that public health officials, sustainability advocates, farmers, and policymakers all need to communicate a lot better and be a lot more open-minded. We will have a hard time improving our food system in a sustainable way without collaboration between all stakeholders. Let’s get comfortable with disagreement, with gray areas, and with the impossibility of a magic bullet, quick fix solution to any of these incredibly complex food issues.

 

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Tl;dr we have to start talking about poverty

As I reach the end of this semester, I’m reflecting on how my views on creating a nourishing, sustainable, and just food system have been enriched by my education inside and outside the classroom.

What has been clear to me for some time is that the food environment, as determined by industry and government, is not compatible with my vision for public health. We produce and market way too much of the wrong foods and not enough of the right ones, the cost structure constrains nutritious choices even further, and we pollute and waste far too much at all levels of food production and consumption.

All of this is still true, and demands to be addressed by the private, public, and non-profit sectors. But, lately I’ve been increasingly confronted by another major crisis that is also at the root of our public health nutrition problems. I am talking about poverty, friends.

I wrote about my Public Health Nutrition class at the beginning of the semester here. I believe I wrote in that post that I had been waiting for this class during my time as an undegrad thus far with much anticipation, mostly because its title is common to that of the particular career field I plan to enter. I expected to know already a lot of the material about the public health nutrition programs run by the government (e.g. SNAP, WIC, the school lunch program) and I did, but what was remarkable was how much the course focused on poverty as a broader issue to frame the public health issues. For example, one of our big assignments was to read and write a paper on one of four books about poverty, none of them focusing especially on nutrition. We also had a guest lecturer come in and talk to us purely about the housing crisis in town next to the university.

When you think about it, it’s easy to see how poverty and the low affordability of things like housing and health insurance are incredibly critical to understanding food insecurity and diet-related disease. But not enough people are thinking about it. Before taking this class, I recognized the connection, but still lamented the flaws of the food environment far more than the miserable extent of poverty.

One of the concepts that the poverty assignment dealt with was flexible versus inflexible expenses. For instance, every month, people have to pay the fixed amount of their rent, utilities, and other bills. Those are the inflexible expenses. They they go to buy their food, and, depending on how much money they have left over, may have to compromise on nutritious foods in order to buy whatever will satisfy them for the least money. For low-income households, government programs like SNAP fill the gap to some extent but don’t typically provide enough to reasonably afford what public health advocates would prescribe as a nutritious diet, and are really only available to the poorest of the poor.

The thing is, food justice and access is so important, and so are welfare programs when they work, but it is equally important for people to be able to rehabilitate and support themselves financially and afford all of this nutritious food to which they may or may not have convenient access, on top of their fixed expenses. If all of those things sound like different names for the same problem, it’s because they are. Too many people are living in poverty (just watch this video about the horrifying income distribution in this country) for the welfare system to sustain itself.

And another thing: everyone demands that food be really cheap, but the externalities of cheap food cost way more in the long run than investing in better quality, nutritious food to begin with (as I lamented in this post). 

The way I see it now, there are two broad, intimidating goals to strive toward in this struggle:

  • Increase the capacity of the social safety net to support people in need with resources to achieve food security
  • Reduce the need for the social safety net by improving equality of opportunity for low-income and disenfranchised populations AND mandating a living wage

I definitely do not have all the answers with regard to how to reach those goals, and really don’t know how to do it in a politically acceptable way (although I do have some thoughts which I may elaborate on in future posts, and always appreciate comments).

Tl;dr: You can’t adequately address food insecurity or the diet-related disease epidemic without addressing poverty.

 

A Healthy Dose of Skepticism

This week, I was extremely fortunate to meet in person with two renowned thought leaders in the field of nutrition.

One was my absolute hero, Marion Nestle, a writer, researcher, public health advocate, and the pioneer in the study of food politics (you can find my other posts about her books here and here).

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The other was T. Colin Campbell, the pioneering scholar of the plant-based nutrition movement. His work on The China Study (which I wrote about here) was one of the first to link diet and health in the public mindset.

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Nutrition nerd that I am, I was quite star struck by both of them. I should point out though, that Dr. Nestle is much more well-liked and respected in the nutrition science community than Dr. Campbell, and I want to explore why that is.

Dr. Campbell has come to be perceived as something of a zealot for a whole food, plant-based diet. He has condemned the dangers of animal products for decades now. He definitely takes a radical approach. I don’t think it would be a stretch to say that he sees the government’s failure to acknowledge the superiority of a whole-food plant based diet as absolutely criminal. Some scholars question whether the methodology of the research cited in The China Study is robust enough to advise everyone to adopt a fully plant-based diet. I admit I haven’t taken a close enough look to be able to comment on that, but when I read it, his evidence seemed compelling. He does come off somewhat angry in his writing, though. In person he was pretty calm, I thought. Obviously people who have an interest in selling animal products would tend to see him as an enemy. What I think is interesting is that Campbell actually grew up on a dairy farm, firmly believing in the life-giving power of a diet rich in animal protein until his own research convinced him otherwise.

Dr. Nestle, on the other hand, comes off as much more skeptical and rational. Twice this week on her blog she advised readers to take any news story that claims “everything you thought you knew about nutrition is wrong” with a grain of salt. Her writing is not angry; she lets the evidence speak for itself in a way that leaves little doubt that the food industry is responsible for much of our nutrition woes.

The thing is, to me, ultimately, the foods that Dr. Nestle defends as the most nutritious are exactly the same as those Dr. Campbell defends—whole grains, legumes, fruits, and vegetables. Dr. Nestle definitely admits that animal products and highly processed foods can be enjoyed in moderation in a health-promoting diet, but she also argues that the evidence has long made clear that the healthiest people eat by Michael Pollan’s creed: “Eat food. Not too much. Mostly plants.”

Both Nestle and Campbell have PhDs in nutritional biochemistry, and I believe both ground their work firmly in scientific evidence, although some people think Campbell is a biased quack. Obviously, at this point I find the evidence compelling enough for me to adopt a completely plant-based diet, but not for nutritional reasons alone, as he argues. I’m sure he is biased, but so are most of us. Dr. Nestle does give the impression of being remarkably objective. She tells it like it is, in a way that any rational person, or scientist for that matter, cannot dispute.

Perhaps many will disagree with me, but I don’t think Nestle’s and Campbell’s diet advice are different enough that they should be regarded so differently as scholars and as advocates. I think Nestle just offers the information in a way that’s much easier to swallow (no pun intended). When I met her this week, she signed my book “Do nutrition, change the world!” Challenge accepted.

Permission to Stuff Your Face

If there is anyone out there who actually reads my posts regularly, I apologize for this long hiatus. I am getting over a rough case of mono, and just haven’t had the wherewithal to write for the last few weeks on top of my schoolwork and other obligations. I have to say, too, that as someone who makes my health such a priority, it has taken a toll on me to feel so out of control of my body as this virus has saddled me with one debilitating symptom after another. Fortunately, I can see the light at the end of the tunnel now, and I might even get back in the gym tomorrow!

Now, it sucks to get mono and other acute illnesses, even for just a few weeks! But a lot of my audience knows that I want to change the way people eat because it will prevent crippling and fatal chronic diseases that afflict more and more people every day.  Actually, to some extent changing the way we eat will prevent infectious disease too.

Throughout my adolescence, I have often thought of healthful eating as limiting the bad stuff. I think this is an attitude that is very common among the health-conscious. Overeating, for many of us, is associated with guilt and shame. Of course, I do feel that highly processed foods and animal products must be limited in order to promote health. As of late, though, I’m coming around to the idea that our diets would actually be more nutritious if we stopped emphasizing what to limit, and told people to eat as much as they can—of the good stuff, that is.

Over my spring break, while I was home sick, I read this great book called How Not to Die by Dr. Michael Greger. It is the most comprehensive review of the scientific evidence about food and health that I’ve come across. Greger addresses the top causes of death in the country, and the foods and behaviors that have been shown to prevent and reverse them. Wonderfully, his conclusions for most of the conditions he covers are very similar: the evidence directs us to eat as many whole plant foods as possible. There is also indication to limit animal products, added sugar, salt, and smoking, but it seems that eating plenty of whole grains, fruits, and vegetables might be more powerful at promoting health than the junk is at detracting from it.

I don’t know about you, but I find that quite liberating. And especially since I’ve become vegan, I do feel free to pile my plate so high with salad that people in the cafeteria gawk at me. I eat as much of those whole foods as I want, I maintain my weight, and I feel great (minus the mono, of course). That’s not to say that I never treat myself to something more indulgent; I definitely do! But I get my fill of fruit and veggies first. As far as I’m concerned, the best thing you can do for your long-term health (not to mention the planet) is to make your default minimally processed plant foods. So EAT UP. DIG IN.

 

Admitting the Virtues of Processed Food

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.

Coming to Terms with my Relationship to Food

For those of you that know me well or have read a lot of my blog posts, you know that I have a complicated relationship with food, and have struggled with my body image for most of my adolescence. I’m definitely less preoccupied with my weight now than I have been in the past, but that may just be because I’ve gotten very good at controlling it. I weigh myself regularly, and if I notice my weight increasing even the slightest bit above what I think it should be, I feel a little “less than,” even if I know rationally that it’s just a temporary fluctuation, and even if I know that it’s just because I ate a ton of broccoli the night before that has yet to clear my digestive tract.

I like to think I’m more concerned with my health than my weight, but deep down I’m still terrified of losing control and gaining weight. Because I’m vegan now, there are a lot of fattening foods I won’t even consider eating anymore, but I still fret about drinking my calories or eating spontaneously when I haven’t planned to. For instance, if I accidentally spill more dressing on my salad than I intended, the thought of those extra calories will bother me slightly at least until I get on the scale again and see a number I like. Typing this out so honestly, I feel like I sound crazy, but I hope this resonates with someone out there.

Of late, this preoccupation with weight has been at the forefront of my mind because I have an injury that’s preventing me from engaging in my normal workout routine. I twisted my ankle, and it’s taking a while to heal. I can’t do any of the cardio I would normally do, like spinning and running and Zumba, and I love my cardio. It makes me feel great and definitely relieves stress, but, like many people, I also associate it with maintaining my weight. I have actually become convinced on an intellectual level in the last few years that the amount of exercise that I and most non-athletes engage in does not really affect one’s weight (especially at my size), but at the same time I still fear that I’ll gain weight if I’m not exercising and don’t eat less to compensate for it.

I have been pleased to find that I am not gaining any noticeable weight while I’m not working out, but it also bothers me that that is still my main concern. I definitely feel fortunate that my anxiety in this regard is not much worse, because I know it is for many people. But I think if I want to make my career about changing the way people eat and promoting a healthful relationship to food, I need to practice what I preach and really work on healing my own.

 

The Five Food Lessons I Wish I Learned in Kindergarten

In an interview for a nutrition policy internship last week, the interviewer asked me what I thought was the most important nutrition issue today, something to the effect of, “If you could wave your wand, what is the one thing you would change?” I first mentioned how much of our dysfunctional food environment can be traced to commodity crop subsidies, but in the end I picked something a bit more adaptable to our current agricultural economy, and that is changing the school food environment. If we want children to grow into adults who have ability and desire to maintain lifelong health, the education has to start from the beginning.

There are some seriously unsettling realities of the global industrial food system that could empower hordes of people to shift their food dollars if only they were aware. I offer myself as Exhibit A. But it took me until college to truly recognize the individual and societal consequences of my food choices — and I was lucky enough to have pretty health-literate parents!

Imagine the impact we could have on public health and food literacy if children were taught about where their food comes from from Day 1. The following is my take on the most essential components of a truly enlightened and nourishing food education that should be mandatory in elementary school.

  1. Growing a vegetable garden: What better way is there to teach a kid how food grows than to have them grow it themselves? Even though the scale of a school garden would be relatively small, students would grow up having some idea of the effort and resources that go into providing them sustenance, as well as an appreciation for the seasonality of different crops (“Why can’t we grow a banana tree?”), not to mention it’s a tailor-made hands-on biology curriculum. Aside from the educational part of it, the garden work would give kids more fresh air and exercise. Even better, kids are usually much more motivated to choose the carrot over the cookie if they grew if themselves.
  2. Visiting farms of all shapes, sizes and products: If you are reading this blog, I probably don’t need to tell you that the average American today is utterly removed (physically and emotionally) from the origin of their food. We can’t expect the public to be able to make the healthier, sustainable, humane choices concerning food if they can’t even associate that hamburger with the ranch from whence it came. We cannot all be farmers (although more of us certainly could), but we can help the next generation of eaters and voters appreciate what farmers do. Everyone needs to be educated to make the best choices for themselves individually and to take part in this critical discussion for society. Why should a field trip to a corn farm or cattle ranch be any less of a priority than a field trip to an aquarium (one memorable field trip I took in first grade)?
  3. Whole-food nutrition and cooking lessons: I guess I shouldn’t be too surprised that eight-year-olds aren’t required to learn about the connection between nutrition and health if the same isn’t even required of most medical students — but that’s a different conversation. There are of course some major issues with food accessibility and affordability for large segments of the population; however, when one is or becomes able to access nutritious food, they need to have the motivation to choose it and the skills to prepare it. It’s hard enough to get a kid who’s grown up snacking on soda and chips to switch to celery and hummus when they know why it’s good for them. We can never realistically expect people to make that change if they have no concept of the health consequences (certainly not in this food economy). Our school system must teach children about how food affects their health, and give them the tools to prepare it in nutritious ways for the rest of their lives. It would be a no-brainer to use the produce from the students’ garden in their recipes. Nutrition also makes for another fantastically practical biology lesson, and cooking could be chemistry, or, for that matter, just plain old essential preparation for life. (Whatever happened to home economics? Why did no one ever teach me how to balance a checkbook or file my taxes?)
  4. Media literacy lessons: If it’s critical for kids to learn why they should be eating whole foods, it’s equally critical for them to learn how to be critical of the food media they consume. Food marketing is everywhere, and it’s overwhelmingly promoting exactly the foods that we should all be minimizing in our diets. Young children are the most vulnerable audience to marketing, while being one of the most heavily targeted audiences by the manufacturers of the most processed, highly palatable, disease-promoting foods on the market. Until and even when health advocates can reign in this type of marketing, we have to equip children with the tools to be able to recognize it and distinguish it from programming that isn’t trying to secure their brand loyalty from the moment they exit the womb.
  5. School food regulations that walk the walk: It would be completely counterproductive if a school implemented all of the programs I described above but still sold junk in the cafeteria and and had a Coca Cola logo plastered across the front of the vending machine. The lessons we teach students in the classroom and the field about food have to be reinforced in situations where they are actually eating and making their own food choices. And stop giving out candy and treats for every little thing. Forgive me for this radical idea, but perhaps cake should stay at birthday parties.

Caveat: I recognize that location, funding, and child age may limit the success of any of these measures or cause them to be adapted, but that’s just what the ideal scenario would look like to me.