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The Politics Of Produce And Public Health

Jim Prevor’s Perishable Pundit, January 31, 2007

Michael Pollan, author most recently of The Omnivore’s Dilemma, is enormously influential, often interesting and a clever stylist, but prone to lay out exhaustive reams of facts, then draw unsupported conclusions from them.

This style was perfectly in evidence in his piece in The New York Times Magazine this past Sunday. The article is called “Unhappy Meals” and you can read it right here.

Pollan devotes thousands of words to pointing out important flaws in our thinking about food and public health:

It was in the 1980s that food began disappearing from the American supermarket, gradually to be replaced by “nutrients,” which are not the same thing. Where once the familiar names of recognizable comestibles — things like eggs or breakfast cereal or cookies — claimed pride of place on the brightly colored packages crowding the aisles, now new terms like “fiber” and “cholesterol” and “saturated fat” rose to large-type prominence. More important than mere foods, the presence or absence of these invisible substances was now generally believed to confer health benefits on their eaters

Put another way, marketing began focusing heavily on “silver bullets” — despite the fact that we know very little about whether eating omega-3 fatty acids or vitamin A-enriched cereal is good, bad or indifferent for people.

In addition, the government sometimes screens what it says due to politics:

Responding to an alarming increase in chronic diseases linked to diet — including heart disease, cancer and diabetes — a Senate Select Committee on Nutrition, headed by George McGovern, held hearings on the problem and prepared what by all rights should have been an uncontroversial document called “Dietary Goals for the United States.” The committee learned that while rates of coronary heart disease had soared in America since World War II, other cultures that consumed traditional diets based largely on plants had strikingly low rates of chronic disease. Epidemiologists also had observed that in America during the war years, when meat and dairy products were strictly rationed, the rate of heart disease temporarily plummeted.

Naïvely putting two and two together, the committee drafted a straightforward set of dietary guidelines calling on Americans to cut down on red meat and dairy products. Within weeks a firestorm, emanating from the red-meat and dairy industries, engulfed the committee, and Senator McGovern (who had a great many cattle ranchers among his South Dakota constituents) was forced to beat a retreat. The committee’s recommendations were hastily rewritten. Plain talk about food — the committee had advised Americans to actually “reduce consumption of meat” — was replaced by artful compromise: “Choose meats, poultry and fish that will reduce saturated-fat intake.”

A subtle change in emphasis, you might say, but a world of difference just the same. First, the stark message to “eat less” of a particular food has been deep-sixed; don’t look for it ever again in any official U.S. dietary pronouncement. Second, notice how distinctions between entities as different as fish and beef and chicken have collapsed; those three venerable foods, each representing an entirely different taxonomic class, are now lumped together as delivery systems for a single nutrient. Notice too how the new language exonerates the foods themselves; now the culprit is an obscure, invisible, tasteless — and politically unconnected — substance that may or may not lurk in them called “saturated fat.”

Note how government timidity and an emphasis on nonfood substances combine to obscure — and in important ways change — the message.

Pollan also points out that a focus on nutrients rather than food disadvantages fresh produce, which cannot be easily reformulated:

In the years following McGovern’s capitulation and the 1982 National Academy report, the food industry set about re-engineering thousands of popular food products to contain more of the nutrients that science and government had deemed the good ones and less of the bad, and by the late ’80s a golden era of food science was upon us. The Year of Eating Oat Bran — also known as 1988 — served as a kind of coming-out party for the food scientists, who succeeded in getting the material into nearly every processed food sold in America. Oat bran’s moment on the dietary stage didn’t last long, but the pattern had been established, and every few years since then a new oat bran has taken its turn under the marketing lights. (Here comes omega-3!)

By comparison, the typical real food has more trouble competing under the rules of nutritionism, if only because something like a banana or an avocado can’t easily change its nutritional stripes (though rest assured the genetic engineers are hard at work on the problem). So far, at least, you can’t put oat bran in a banana. So depending on the reigning nutritional orthodoxy, the avocado might be either a high-fat food to be avoided (Old Think) or a food high in monounsaturated fat to be embraced (New Think). The fate of each whole food rises and falls with every change in the nutritional weather, while the processed foods are simply reformulated. That’s why when the Atkins mania hit the food industry, bread and pasta were given a quick redesign (dialing back the carbs; boosting the protein), while the poor unreconstructed potatoes and carrots were left out in the cold.

Of course it’s also a lot easier to slap a health claim on a box of sugary cereal than on a potato or carrot, with the perverse result that the most healthful foods in the supermarket sit there quietly in the produce section, silent as stroke victims, while a few aisles over, the Cocoa Puffs and Lucky Charms are screaming about their newfound whole-grain goodness.

It turns out that a focus on substances rather than foods often is perceived as permission to eat more of the right thing:

I would submit that the ideology of nutritionism deserves as much of the blame as the carbohydrates themselves do — that and human nature. By framing dietary advice in terms of good and bad nutrients, and by burying the recommendation that we should eat less of any particular food, it was easy for the take-home message of the 1977 and 1982 dietary guidelines to be simplified as follows: Eat more low-fat foods. And that is what we did. We’re always happy to receive a dispensation to eat more of something (with the possible exception of oat bran), and one of the things nutritionism reliably gives us is some such dispensation: low-fat cookies then, low-carb beer now. It’s hard to imagine the low-fat craze taking off as it did if McGovern’s original food-based recommendations had stood: eat fewer meat and dairy products. For how do you get from that stark counsel to the idea that another case of Snackwell’s is just what the doctor ordered?

As it happens, we know very little about what the doctor should order nutrition-wise:

Most nutritional science involves studying one nutrient at a time, an approach that even nutritionists who do it will tell you is deeply flawed. “The problem with nutrient-by-nutrient nutrition science,” points out Marion Nestle, the New York University nutritionist, “is that it takes the nutrient out of the context of food, the food out of the context of diet and the diet out of the context of lifestyle.”

If nutritional scientists know this, why do they do it anyway? Because a nutrient bias is built into the way science is done: scientists need individual variables they can isolate. Yet even the simplest food is a hopelessly complex thing to study, a virtual wilderness of chemical compounds, many of which exist in complex and dynamic relation to one another, and all of which together are in the process of changing from one state to another. So if you’re a nutritional scientist, you do the only thing you can do, given the tools at your disposal: break the thing down into its component parts and study those one by one, even if that means ignoring complex interactions and contexts, as well as the fact that the whole may be more than, or just different from, the sum of its parts. This is what we mean by reductionist science.

Scientific reductionism is an undeniably powerful tool, but it can mislead us too, especially when applied to something as complex as, on the one side, a food, and on the other, a human eater. It encourages us to take a mechanistic view of that transaction: put in this nutrient; get out that physiological result. Yet people differ in important ways. Some populations can metabolize sugars better than others; depending on your evolutionary heritage, you may or may not be able to digest the lactose in milk. The specific ecology of your intestines helps determine how efficiently you digest what you eat, so that the same input of 100 calories may yield more or less energy depending on the proportion of Firmicutes and Bacteroidetes living in your gut. There is nothing very machinelike about the human eater, and so to think of food as simply fuel is wrong.

Also, people don’t eat nutrients, they eat foods, and foods can behave very differently than the nutrients they contain. Researchers have long believed, based on epidemiological comparisons of different populations, that a diet high in fruits and vegetables confers some protection against cancer. So naturally they ask, What nutrients in those plant foods are responsible for that effect? One hypothesis is that the antioxidants in fresh produce — compounds like beta carotene, lycopene, vitamin E, etc. — are the X factor. It makes good sense: these molecules (which plants produce to protect themselves from the highly reactive oxygen atoms produced in photosynthesis) vanquish the free radicals in our bodies, which can damage DNA and initiate cancers. At least that’s how it seems to work in the test tube. Yet as soon as you remove these useful molecules from the context of the whole foods they’re found in, as we’ve done in creating antioxidant supplements, they don’t work at all. Indeed, in the case of beta carotene ingested as a supplement, scientists have discovered that it actually increases the risk of certain cancers. Big oops.

How is this possible? Why is there such confusion?

What’s going on here? We don’t know. It could be the vagaries of human digestion. Maybe the fiber (or some other component) in a carrot protects the antioxidant molecules from destruction by stomach acids early in the digestive process. Or it could be that we isolated the wrong antioxidant. Beta is just one of a whole slew of carotenes found in common vegetables; maybe we focused on the wrong one. Or maybe beta carotene works as an antioxidant only in concert with some other plant chemical or process; under other circumstances, it may behave as a pro-oxidant.

Indeed, to look at the chemical composition of any common food plant is to realize just how much complexity lurks within it. Here’s a list of just the antioxidants that have been identified in garden-variety thyme:

4-Terpineol, alanine, anethole, apigenin, ascorbic acid, beta carotene, caffeic acid, camphene, carvacrol, chlorogenic acid, chrysoeriol, eriodictyol, eugenol, ferulic acid, gallic acid, gamma-terpinene isochlorogenic acid, isoeugenol, isothymonin, kaempferol, labiatic acid, lauric acid, linalyl acetate, luteolin, methionine, myrcene, myristic acid, naringenin, oleanolic acid, p-coumoric acid, p-hydroxy-benzoic acid, palmitic acid, rosmarinic acid, selenium, tannin, thymol, tryptophan, ursolic acid, vanillic acid.

This is what you’re ingesting when you eat food flavored with thyme. Some of these chemicals are broken down by your digestion, but others are going on to do undetermined things to your body: turning some gene’s expression on or off, perhaps, or heading off a free radical before it disturbs a strand of DNA deep in some cell. It would be great to know how this all works, but in the meantime we can enjoy thyme in the knowledge that it probably doesn’t do any harm (since people have been eating it forever) and that it may actually do some good (since people have been eating it forever) and that even if it does nothing, we like the way it tastes.

In any case, all the studies we have are very questionable. Some take the nutrient out of the context of the diet:

…as Nestle suggests, scientists make a second, related error when they study the food out of the context of the diet. We don’t eat just one thing, and when we are eating any one thing, we’re not eating another. We also eat foods in combinations and in orders that can affect how they’re absorbed. Drink coffee with your steak, and your body won’t be able to fully absorb the iron in the meat. The trace of limestone in the corn tortilla unlocks essential amino acids in the corn that would otherwise remain unavailable. Some of those compounds in that sprig of thyme may well affect my digestion of the dish I add it to, helping to break down one compound or possibly stimulate production of an enzyme to detoxify another. We have barely begun to understand the relationships among foods in a cuisine.

But we do understand some of the simplest relationships, like the zero-sum relationship: that if you eat a lot of meat you’re probably not eating a lot of vegetables. This simple fact may explain why populations that eat diets high in meat have higher rates of coronary heart disease and cancer than those that don’t. Yet nutritionism encourages us to look elsewhere for the explanation: deep within the meat itself, to the culpable nutrient, which scientists have long assumed to be the saturated fat. So they are baffled when large-population studies, like the Women’s Health Initiative, fail to find that reducing fat intake significantly reduces the incidence of heart disease or cancer.

Of course thanks to the low-fat fad (inspired by the very same reductionist fat hypothesis), it is entirely possible to reduce your intake of saturated fat without significantly reducing your consumption of animal protein: just drink the low-fat milk and order the skinless chicken breast or the turkey bacon. So maybe the culprit nutrient in meat and dairy is the animal protein itself, as some researchers now hypothesize. (The Cornell nutritionist T. Colin Campbellargues as much in his recent book, “The China Study.”) Or, as the Harvard epidemiologist Walter C. Willett suggests, it could be the steroid hormones typically present in the milk and meat; these hormones (which occur naturally in meat and milk but are often augmented in industrial production) are known to promote certain cancers.

Others take the diet out of the context of lifestyle:

The Mediterranean diet is widely believed to be one of the most healthful ways to eat, yet much of what we know about it is based on studies of people living on the island of Crete in the 1950s, who in many respects lived lives very different from our own. Yes, they ate lots of olive oil and little meat. But they also did more physical labor. They fasted regularly. They ate a lot of wild greens — weeds. And, perhaps most important, they consumed far fewer total calories than we do. Similarly, much of what we know about the health benefits of a vegetarian diet is based on studies of Seventh Day Adventists, who muddy the nutritional picture by drinking absolutely no alcohol and never smoking. These extraneous but unavoidable factors are called, aptly, “confounders.” One last example: People who take supplements are healthier than the population at large, but their health probably has nothing whatsoever to do with the supplements they take — which recent studies have suggested are worthless. Supplement-takers are better-educated, more-affluent people who, almost by definition, take a greater-than-normal interest in personal health — confounding factors that probably account for their superior health.

Even our most scientific studies are problematic sometimes because we don’t ask the right questions:

But if confounding factors of lifestyle bedevil comparative studies of different populations, the supposedly more rigorous “prospective” studies of large American populations suffer from their own arguably even more disabling flaws. In these studies — of which the Women’s Health Initiative is the best known — a large population is divided into two groups. The intervention group changes its diet in some prescribed manner, while the control group does not. The two groups are then tracked over many years to learn whether the intervention affects relative rates of chronic disease.

When it comes to studying nutrition, this sort of extensive, long-term clinical trial is supposed to be the gold standard. It certainly sounds sound. In the case of the Women’s Health Initiative, sponsored by the National Institutes of Health, the eating habits and health outcomes of nearly 49,000 women (ages 50 to 79 at the beginning of the study) were tracked for eight years. One group of the women were told to reduce their consumption of fat to 20 percent of total calories. The results were announced early last year, producing front-page headlines of which the one in this newspaper was typical: “Low-Fat Diet Does Not Cut Health Risks, Study Finds.” And the cloud of nutritional confusion over the country darkened.

But even a cursory analysis of the study’s methods makes you wonder why anyone would take such a finding seriously, let alone order a Quarter Pounder With Cheese to celebrate it, as many newspaper readers no doubt promptly went out and did. Even the beginner student of nutritionism will immediately spot several flaws: the focus was on “fat,” rather than on any particular food, like meat or dairy. So women could comply simply by switching to lower-fat animal products. Also, no distinctions were made between types of fat: women getting their allowable portion of fat from olive oil or fish were lumped together with woman getting their fat from low-fat cheese or chicken breasts or margarine. Why? Because when the study was designed 16 years ago, the whole notion of “good fats” was not yet on the scientific scope. Scientists study what scientists can see.

People often lie about what they eat:

But perhaps the biggest flaw in this study, and other studies like it, is that we have no idea what these women were really eating because, like most people when asked about their diet, they lied about it. How do we know this? Deduction. Consider: When the study began, the average participant weighed in at 170 pounds and claimed to be eating 1,800 calories a day. It would take an unusual metabolism to maintain that weight on so little food. And it would take an even freakier metabolism to drop only one or two pounds after getting down to a diet of 1,400 to 1,500 calories a day — as the women on the “low-fat” regimen claimed to have done. Sorry, ladies, but I just don’t buy it.

In fact, nobody buys it. Even the scientists who conduct this sort of research conduct it in the knowledge that people lie about their food intake all the time. They even have scientific figures for the magnitude of the lie. Dietary trials like the Women’s Health Initiative rely on “food-frequency questionnaires,” and studies suggest that people on average eat between a fifth and a third more than they claim to on the questionnaires. How do the researchers know that? By comparing what people report on questionnaires with interviews about their dietary intake over the previous 24 hours, thought to be somewhat more reliable. In fact, the magnitude of the lie could be much greater, judging by the huge disparity between the total number of food calories produced every day for each American (3,900 calories) and the average number of those calories Americans own up to chomping: 2,000. (Waste accounts for some of the disparity, but nowhere near all of it.) All we really know about how much people actually eat is that the real number lies somewhere between those two figures.

To try to fill out the food-frequency questionnaire used by the Women’s Health Initiative, as I recently did, is to realize just how shaky the data on which such trials rely really are. The survey, which took about 45 minutes to complete, started off with some relatively easy questions: “Did you eat chicken or turkey during the last three months?” Having answered yes, I was then asked, “When you ate chicken or turkey, how often did you eat the skin?” But the survey soon became harder, as when it asked me to think back over the past three months to recall whether when I ate okra, squash or yams, they were fried, and if so, were they fried in stick margarine, tub margarine, butter, “shortening” (in which category they inexplicably lump together hydrogenated vegetable oil and lard), olive or canola oil or nonstick spray? I honestly didn’t remember, and in the case of any okra eaten in a restaurant, even a hypnotist could not get out of me what sort of fat it was fried in.

Sometimes we seem to design the studies without thinking how the questions affect the way people answer them:

In the meat section, the portion sizes specified haven’t been seen in America since the Hoover administration. If a four-ounce portion of steak is considered “medium,” was I really going to admit that the steak I enjoyed on an unrecallable number of occasions during the past three months was probably the equivalent of two or three (or, in the case of a steakhouse steak, no less than four) of these portions? I think not. In fact, most of the “medium serving sizes” to which I was asked to compare my own consumption made me feel piggish enough to want to shave a few ounces here, a few there. (I mean, I wasn’t under oath or anything, was I?)

Up to this point Pollan is insightful and useful. Then he starts (and to his credit admits that he is doing so) making things up. He gives his 10 points of advice on what we should eat and what we shouldn’t.

He is very influential and we link to the article and quote it at such length because this is not the last you will hear of Pollan or his work.

The problem is that the implication of all this is that our ways of thinking about food and nutrition are flawed. Our research is very weak and we don’t know that much about these things.

Logically, this admission that our science is weak should lead to a call for more and better science. Instead we skip over that nicety and get Pollan’s 10-point plan on how to eat, which is, as he says, “flagrantly unscientific.” If you have the same predispositions and prejudices as Michael Pollan, you will think these ideas brilliant. If not, he barely tries to convince you.

There were comments in the article that should make us think of some of our 5-a-Day efforts. As we drifted into the 5-a-Day the Color Way campaign, there were real questions as to the strength of the science. It has not been firmly established what benefits, if any, humans derive from increasing the amount of “white” produce items in their daily diets.

Now, as we go to the new “More Matters” campaign, one thinks of Michael Pollan’s point that, due to a political uproar, the McGovern committee revised itself after initially urging people to eat less red meat and fewer dairy products.

Is the health benefit of produce really in eating more produce? Or is it the substitution effect that comes from eating less meat or fewer dairy products, or something else?

In other words, is there some science that suggests that if a person continues his normal diet but forces himself to eat more produce before going to bed, he will be healthier?

If not, is the produce industry punting, as the McGovern committee did? Is the trade, in its attempt to avoid disparaging other commodities, giving out a confusing public health message?

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