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- Anthony N. DeMaria, MD, Editor-in-Chief, Journal of the American College of Cardiology⁎ ()
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Dr. Anthony N. DeMaria, Editor-in-Chief, Journal of the American College of Cardiology, 3655 Nobel Drive, Suite 630, San Diego, California 92112
There is no question that over the years I have become an overbearing evangelist for “a healthy lifestyle,” particularly in regard to diet. Confronted with illnesses that are not infrequently contributed to or even induced by self behavior, most physicians develop an enormous respect for and become vocal advocates of hygienic living. This is probably particularly true for cardiologists. In my case it started with the avoidance of obvious risk factors, such as smoking and obesity, and gradually progressed to vigorous exercise conditioning and a low-fat, low-carbohydrate diet. I only ate vitamin-enriched, high-fiber, heart-healthy cereals tasting like cardboard, threw away the bread from sandwiches, drank fat-free milk or caffeine-free diet soft drinks, and subsisted primarily on salads with low-calorie/fat-free dressings. Not only did I practice this myself, but often saw fit to chastise or at least kid companions who did not conduct themselves similarly. However, I have recently undergone a substantial transformation.
While browsing through a bookstore recently I came across a fascinating book titled In Defense of Foodby Michael Pollan (1). The book was a follow-up of a national best seller titled The Dilemma of the Omnivore(2), in which the author indirectly made the provocative suggestion that most of what we eat can ultimately be traced to petroleum. The author followed the food chain from its growth as fertilizer-enhanced corn or soy beans to corn-fed beef or to soy and corn syrup, which is ubiquitous in the processed food we eat. He argued that nutrition science had succeeded in breaking down plants and animals into their component parts and then reassembling them into high-value added food systems that were neither high value nor, in fact, actually food. The fabricated products were often high calorie, toxic, or contaminated with antibiotics or hormones.
In Defense of Foodaddresses the issue of what should we eat. Pollan marvels that such a topic should even come up, since eating is one of the most instinctive functions in nature; animals need no such counseling, and neither did we until recent generations. However, we now deal on a daily basis with dietary guidelines, nutrition science, and detailed food labeling. Much like my own progression from avoiding high-calorie/saturated fat foods with little nutritional value to eating only those with very low fat and low carbohydrates, we have come to view eating not as a natural activity of life, but as a means to promote health.
Pollan attributes much of the evolution of our concepts regarding eating to nutrition science and food marketing. He traces the origins of the concepts to 2 events: a recommendation of a Senate Committee in response to the lipid hypothesis promoted by the American Heart Association “to choose food that will reduce saturated fat,” and a proclamation by the Food and Drug Administration that processed edibles could not be classified as imitations if they were “nutritionally equivalent” to the natural food. This led to industrialization of food whereby the foodstuff itself was no longer considered, but rather the nutrients contained. Foodstuffs now became highly processed, refined, and fortified with compounds that were perceived to be beneficial to health. As a result, Pollan argues, the Western diet evolved not as natural food, but as fabricated edibles, based upon seeds rather than whole plants, containing multiple additives and derivatives, and lacking in fiber, antioxidants, phytochemicals, and likely other unidentified constituents. He further proposes that these changes have not benefited health, but rather have been detrimental.
Given these considerations, the recommendation follows to “eat food, not very much, mostly plants” (1). With tongue only slightly in cheek, Pollan advocates avoiding any edible product that is unfamiliar, has more than 5 or any unpronounceable ingredients, contains high fructose corn syrup, does not rot, or makes health claims, since it is not natural food. In fact, he suggests that very little true food is found in supermarkets, and if you do shop there, it should only be around the periphery and not in the center of the store. He endorses the well-documented relationship between low-caloric intake and longevity, and urges that we stop eating before we are full. He argues for consumption primarily of whole plants, although occasional ingestion of meat is felt to be fine. The sociology of eating is also emphasized. We are advised to eat slowly and with others, and only at a table. The concept of eating as an important setting for communication and culture rings true, and may well be an important explanation of the “French paradox.”
Reading Pollan's books made a definite impression on me. There was clearly some overstatement, and some of the nutritional data cited were weak, but overall the thesis was imminently believable. In an effort to use eating to promote health, and to increase consumption of foodstuffs by society, nutritionists and food marketers have probably distorted our dietary habits. The industrialization of food has resulted in the paradox of processed food intended to increase health, which may have an adverse effect on well being. For instance, the trans fats in margarine were toxic, whereas butter has many beneficial ingredients.
I had bought into the concept of “healthy eating” without fully considering the implications. I was unaware, for instance, that the production of fat-free milk entailed the addition of powder, which contains oxidized lipids, to thicken the product. I have routinely consumed low-calorie frozen dinners and low-carbohydrate snacks, each of which consists of many more than 5 ingredients. Further, I had somewhat arrogantly encouraged this behavior for my family, friends, and patients. I now feel somewhat chastised myself.
While I am a bit tempted to make up for the past by indulging in a huge bacon and cheese omelet with lots of bread and butter and an ice cream sundae for dessert, the basic principles of good foods and healthy eating are still intact. Rather than seeking the perfect diet, I will seek the best and healthiest food. Going forward I will focus on natural, unprocessed “food,” eat small portions, and emphasize fruits and vegetables.
Please note: The title is from Pollan (1).
- American College of Cardiology Foundation