The entire approach to food based on nutrients is wrong

The science of nutrition is changing and not in the way you might expect. After years of “reductionist” thinking — where food has been viewed as the sum of its parts – a call to treat food as food has been sounded. No more poring over nutrition labels to calculate grams of fat or chasing down the latest go-to chemical – be it vitamin E, fish oil or omega-3. Instead we are being asked to call a potato a potato and a piece of steak, well, a piece of steak.

If you haven’t heard about this sea change yet, you are not alone. The food science industry that markets “food products” for our consumption has done a good job giving their laboratory creations a semblance of health with phrases like “low fat” and “high in vitamin C.” For our part, the medical community is also to blame. Despite evidence to the contrary, we have been slow to renounce the “fat is bad” mantra or break away from the nutrient-based approach to eating that first swept the country over 30 years ago.

Until very recently, the dissenting opinion was expressed mainly by food journalists and self-proclaimed naturalists. In the book Good Calories, Bad Calories, Gary Taubes argues persuasively that the science behind vilifying fats is fatally flawed and proposes that carbohydrates, and in particular sugar and high fructose corn syrup, are the real bad guys. Michael Pollan, perhaps the best quoted food journalist-cum-activist, goes further to suggest the whole notion of understanding food by its constituent parts – fat, protein and carbohydrates or even saturated fats, unsaturated fats, and trans fats – is plain wrong. He opens In Defense of Food with three dictums for healthful eating: “Eat food. Not too much. Mostly plants.”

Now the scientific and medical literature is coming around. A review in the Archives of Internal Medicine of over 500 trials found “insufficient evidence” that the intake of dietary fat (except for trans fat) is associated with coronary heart disease. More recently, an editorial published in the Journal of the American Medical Association (JAMA) August 2010 entitled “Dietary Guidelines in the 21st Century – a Time for Food” writes “little of the information found on food labels’ ‘nutrition facts’ panels provides useful guidance for selecting healthier foods to prevent chronic disease.”

Don’t let the plain academic language lull you – what these scientists have published in arguably the world’s most prestigious medical journal is that the entire approach to food based on nutrients is wrong.

It’s not that eating the right nutrients is hard (how are you supposed to know if less than 30% of your calories comes from saturated fats?) and that the science of nutrient-based eating is bad (this is too academic to get worked up about), it’s that our focus on nutrients has actually made our food more unhealthy. In an effort to engineer “better” foods, we created trans fats, which we now know are deleterious to health, and food products that are low in fat but high in dough conditioners (whatever that is). Indeed, as saturated fat consumption has decreased, our collective burden of chronic disease and obesity has only increased.

So if fat is not bad, and we shouldn’t be thinking about food in terms of individual nutrients, what are we left with? Surprisingly, we are pretty much where we were in our grandparents’ generation, a time before we thought we could improve health by manipulating individual nutrients, and when food was just food. As the JAMA article concludes “… although this approach may seem radical, it actually represents a return to more tradition, time-tested ways of eating.”

In fact, the most convincing studies of dietary patterns that prevent or retard chronic disease are food-based. Fruits, vegetables, whole grains, and nuts have been consistently associated with lower risk of disease while fish consumption has lowered the risk of death from heart disease. And these effects are above and beyond what you see from diets with equal levels of protein, fat, and carbohydrates.

A food-based approach to eating is not only healthier but also easier. Instead of worrying about things you can’t see, smell or taste; it asks you to pay attention to what you are putting in your mouth. It supports an eating plan of fruits and vegetables, whole grains, and unfettered meats over processed foods, packaged meats, and sugar-laden beverages; and favors home-cooked food over store-brought or restaurant meals.

So the next time the hunger pangs strike, check your energy bar at the door and drive on by the local diner. Instead go to your local grocery store, buy yourself some fresh food, and prepare yourself a hearty, wholesome and healthy meal.

Shantanu Nundy is an internal medicine physician and author of Stay Healthy At Every Age: What Your Doctor Wants You to Know.

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  • Ybi Girl

    Bravo!

    After +10 years of suffering with gluten intolerance and MDs throwing their hands in the air as my body faltered, I was lucky enough to take my nutrition issues into my own hands. My MD still looks at me sideways when I state being a vegetarian nearly killed me, meanwhile her “skinny-fat” body, facial acne, and dark circles under her eyes forecast a painful future for her body and mind. She is clearly gluten intolerant, yet continues her vegan diet unaware that the grains are slowly eroding her health.

    I think Chinese Doctors had it right, generations ago:

    “The superior doctor prevents sickness;

    The mediocre doctor attends to impending sickness;

    The inferior doctor treats actual sickness.”

    Chinese Proverb

  • http://twitter.com/andreivkovic Andre

    Great post. It reminds me of the famous quote “let food be your medicine and medicine be your food”..nothing in there about divying food up into nutrients! :)

  • Anonymous

    This is a disappointing title and long winded piece that I find contributes little to helping others understand the role  nutrition plays in their health. Healthy eating is much more complex than simply stating, “a food-based approach to eating is not only healthier but also easier” or simply eat grandmas homemade fruits and vegetables rather than store bought processed foods…food is made of nutrients and good health comes from nourishing your body with those nutrients…How many nutrition courses are required of MDs? It’s interesting after so many years of physicians ignoring the fundamentals of nutrition and exercise while writing prescriptions for drugs to treat their patients they are now becoming “experts” in nutrition and health…perhaps after so many years of ignoring patients weight gain there’s a new business for them? You’re just discovering what the food industry has known for years…how to make a profit.

    • Ybi Girl

      Just to answer your question about nutrition education. I read a report a couple months ago stating 60% of MD programs in the US have less than 20 hours devoted to nutrition.

  • Anonymous

    Another Michael Pollan food rule:  “Don’t eat anything your great grandmother wouldn’t recognize as food”. 
    Also suggest getting a copy of “Nourishing Traditions” by Sally Fallon for (quote) “delicious meals, increased vitality, robust children and freedom from the chains of acute and chronic illness”.  I’m on their team!

  • http://twitter.com/HeartSisters carolyn thomas

    You know something is terribly wrong when the makers of Froot Loops (a breakfast cereal that’s almost 50% sugar by weight) are bragging about
    the health benefits of the product’s added fiber!  Unlike FitRD, I believe that, as you say here, “a food-based approach to eating is not only healthier but easier…”  It doesn’t have to be more “complex” than Michael Pollan’s brilliant “Eat food. Not too much. Mostly plants.” 

    The point of this post seems to be that consumers have been hoodwinked by mega-corporate spin into believing a lot of stuff that just isn’t true – for example, that even junk like Froot Loops can be a good breakfast for our children if Kellogg’s adds fiber to it, instead of looking at this product for what it actually is.  It’s a food-style product – NOT FOOD.  More on this at “Snake Oil In Your Snacks” – http://ethicalnag.org/2010/06/01/snake-oil-snacks/

  • http://pulse.yahoo.com/_ALPUXAS5GHTK3R6KRFWE7KRXLA Just Meint

    I like this article, but it needs a section reworking.
    Nutrient panels (etc) are usually only visible on prepackaged …. processed ….. shop/industrially prepared food stuffs.
    If you avoid like the plague as many as possible of these foods – essentially eat healthy home prepared food stuffs you cannot go wrong. YES eat like your grandmother used to!

  • Anonymous

    I realize that stories aren’t data, but nevertheless my husband and I, both overweight and over fifty, ditched all the fake food that hasn’t helped us much (especially me, the professional dieter of the pair) and are doing what the article suggests…cooking real food at home.  Yes, it means real butter on the sweet ‘taters and a spponful of real sugar in the coffee…which has led us to a small but sustained weight loss without hnger or fatigue.  Our labs rocks, as well.  I will always be plump….it is in my DNA and pelvic girdle size…..but hopefully a bit less so with better health.

  • Anonymous

    The concept of whole foods is crucial. Recent developments in research of the metabolic effects of the microbiome may suggest why ‘degree of refinement’ is the central key to the “western diseases”. Researchers are feeding mice corn oil / lard mixtures, and observing how the gut bacteria change as the mice become obese and insulin-resistant, and how the mice simply do not fatten or get leptin or insulin changes if the gut microbiota are absent. As in humans, the obesity and metabolic effects are accompanied by low level inflammation and elevated circulating bacterial markers.

    The cognitive leap that they have not yet put forward in print, is the excellent position the microbiome is in to detect refinement in foods. Whole foods were recently alive. Living things do not spontaneously undergo rapid degradation by bacteria. However, refined foods are mixtures of nutrients, with their evolved mechanisms against bacterial action stripped away. This is now bug food. We now know a misbehaving gut bug population is a crucial step in metabolic disregulation and obesity of the host.

    When Kitavans eat roughly the same macronutrient profile as Americans, they do so without a trace of overweight or insulin-resistance in their population, because they eat starchy root veg, fruit and coconuts. No fast-food for bugs, no bacterial overgrowth, no metabolic disregulation. Kids from Burkina Faso have been shown to have a radically different microbiome to those in the EU.

    @Pattie BRN – that ‘real sugar’ in your coffee is likely part of the problem under this hypothesis. Also anything with flour in it – it’s all refined well beyond the hand-pounded materials associated with less obesity-troubled early agrarians (As an aside, the lectins in most grains mean they’re not ideal even in a coarser state).

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