For National Nutrition Month, Please Don’t Eat the Malarkey (i.e., renounce death by dietary boondoggle)

David L. Katz, MD, MPH, FACPM, FACP, FACLM
LinkedIn
March, according to the lore we all know, comes in like a lion and goes out like a lamb. Given what we have done to the climate and planet, who knows what it will do, or whether there will be any lions for much longer. But those are topics for another day.
Cartoon leprechaun dressed in a green suit with brown belt and green top hat offers with outstretched hands a 4-leaf clover to the viewer.

Little lambs, also according to lore most of us know, eat ivy, given the opportunity. Lions, of course, given hunger and the opportunity, will readily eat little lambs. Which leads to what is likely less known lore: March is National Nutrition Month, for whatever reason. So we should talk about food.

March is also home, once past the notorious ides, to the frothy cheer of St. Patty’s Day. The confluence of all this might warrant swapping recipes for corned beef and cabbage, but I don’t eat beef, corned or otherwise. For me, the relevant Irish icons of all this are: leprechauns, and malarkey. Let’s talk about those.

Sadly, the best-known leprechaun in our culture makes a living encouraging our children to eat multi-colored marshmallows as “part of their complete breakfast.” To be fair, Lucky Charms is scarcely a stand-out in the “kid cereal” category- but even so, with 5 grams of added sugar for each gram of fiber, a higher ratio of sodium to calories than Lay’s classic potato chips, and minimally 4 artificial food dyes involved in the making of those psychedelic marshmallows, it is a dubious proposition at best for the “most important meal of the day.”

"Original Lucky Charms" cereal box and marketing description of the "gluten free" cereal and hearts, stars moons, and other marshmellow ingredients that make Lucky Charms magically delicious.

But I think the signature issue for this National Nutrition Month– and perhaps THIS national nutrition month especially- is malarkey.

Little lambs eat ivy, and lions may eat little lambs; humans will eat anything you peddle to them. Feed any of the ultraprocessed junk we human parents of modern culture pass blithely to our own offspring to any species other than our own, and you are apt to face charges of animal abuse. Yet, as the consequences hide in plain sight, it is our business as usual to give our kids junk and invite them to pretend it’s food.

Why is such malarkey especially relevant THIS National Nutrition Month, as opposed to the others, past and future?

Because we remain mired in the COVID pandemic this National Nutrition Month, with two quite relevant reverberations. First, as horrified as we all are that the pandemic has claimed over 500,000 American lives (by causing deaths earlier than they would otherwise have occurred) in the past year- we are seemingly contemptuous of the fact that junk masquerading as food claims over 500,000 American lives (by just that same definition) EVERY year.

Second, our national discourse is dominated in this moment by talk of vaccines- and that talk, in turn, much dominated by vaccine reticence. Here’s my question: how can a society so concerned about the potential harms of putting into our bodies a product expressly designed to save lives (i.e., vaccines)- so cavalierly put into our bodies, and those of our kids, every day products willfully engineered to be addictive, and propagate obesity, diabetes, and other such carnage- for profit? I will indulge in the cheek of vernacular, and sum this up as: inconsistent, much?

We are mired in nutritional malarkey.

For grown-ups, the pretense of macronutrients likely tops the list, so as promised last time– I turn now to that.

The idea that adjusting intake of a “macronutrient” could meaningfully alter overall diet quality dates back to a time when macronutrients came only, or at least principally, from actual foods. When Ancel Keys first advised limiting intake of saturated fat in the middle of the 20th century- and when that message was regrettably generalized to all dietary fat by other agents – the principal sources of saturated fat were meat and dairy. Thus, limiting saturated fat intake meant eating more of the real foods that were not major sources, notably, vegetables, legumes, fruits, whole grains, nuts and seeds; and making room for those by eating less meat and dairy. Such guidance was perfectly sound then, and is perfectly sound now; it aligns with the weight of evidence; it redounds to the benefit of people and planet alike.

This value proposition all changed, however, when junk became an evolving food group, relying on ultra-processing to address any particular nutrient fixation. Since the 1970s or 1980s, it has been possible to avoid just about any given nutrient or ingredient, and indulge in junk food engineered to satisfy that one requirement. In other words, you can cut your fat and have your low-fat junk food, too; or do the same with carbohydrate, gluten, glycemic index, fructose, and so on.

That is the great tragedy of modern nutrition– captured in two aphorisms. The first, courtesy of Newton, is that for every action, there is an equal and opposite reaction. The second is that those who don’t learn from the follies of history are destined to repeat them.

Combine these, and the follies of history become the actions; their equally misguided repetition in the opposing direction, the reaction. Chew, swallow, repeat- and you have modern nutrition, sliced and diced. Do you want fries with that?

While macronutrient thresholds never provided much useful information about diet quality and implications for health, in the age of willfully engineered, diverse junk foods- they are almost entirely meaningless.

A diet might be high or low in total carbohydrate, fat, and to a lesser extent protein- and be a diet of extreme high or extreme low quality. Examples are readily available. Among the Blue Zone dietary patterns associated with extreme longevity and vitality, the Mediterranean diet in both Ikaria, Greece and Sardinia, Italy is natively quite high in total fat, from extra virgin olive oil in particular. In contrast, the traditional dietary pattern of Okinawa, Japan, also a Blue Zone, is extremely low in total fat. In neither case is the diet predicated on ‘being’ high or low in fat- they just happen to be one or the other, because of the assembly of foods.

Also of note, the native diet of Tsimane foragers in the Amazon, associated with uniquely good cardiovascular health, is extremely high in carbohydrate. What this really means, however, is that the diet is made up mostly of plants, all of which are carbohydrate sources, supplemented with some fishing and hunting. Multicolored marshmallows are nowhere to be found.

Thus, whatever historical meaning “low fat” or “low carbohydrate” may have had- limiting fatty meat and dairy in the first case, emphasizing those in the second- they no longer have. In the age of ultraprocessed foods, macronutrient thresholds say nearly nothing about the wholesomeness of foods selected, or the balance of the overall dietary pattern.

Macronutrient thresholds are not indicative of diet quality or predictive of health effects even when linked to the very genes that argue most emphatically they should be. In the DIETFITS study, for instance, individuals with impaired insulin sensitivity and genes predictive of poor “carbohydrate tolerance” at baseline were randomly assigned to a low-fat or a low-carbohydrate diet of comparable, objective quality (i.e., both made up principally of “real” foods). Despite anticipation that insulin resistance would respond better to carbohydrate restriction, these study participants did identically well on both intervention diets with no appreciable differences between groups.

This is a generalizable point. Regardless of genome or microbiome or insulin sensitivity, most people will do very well on a plant-predominant diet of genuinely wholesome, mostly whole foods in any sensible, balanced assembly. Such a diet- whether low or high in total fat, relatively low or high in total carbohydrate- will tend to outperform any version of the “typical” modern diet by any measure of importance, from biomarkers of cardiovascular health, to satiety, to vitality and longevity. The general argument that people will lose weight more reliably on a low carbohydrate diet has been debunked, any number of times in a decisive variety of ways.

A diet of wholesome, mostly whole plant foods in a balanced assembly will be lower in total fat if added oils, nuts, seeds, olives and avocado are de-emphasized. It will be higher in fat if such foods, and to a lesser extent fish and seafood, are prioritized. Either way, a balanced array of fatty acids will tend to result, and imbalances- such as the prevailing excess of saturated fat and relative surfeit of omega-6 fat to omega-3 – will be avoided. Imbalance, since it speaks to a conflict with native adaptations, is always a dietary demerit; balance, always a favored attribute. Similarly, a plant-predominant diet of wholesome foods will be higher in carbohydrate with a focus on vegetables, fruits, and grains- or lower with a shift to foods higher in fat and protein, notably legumes, avocado, nuts, and seeds.

The bottom line is that the fundamental distinction between diets low and high in quality is not an arbitrary macronutrient threshold, but the presence or absence of wholesome, minimally processed, real foods in a balanced, sensible, and at best time-honored assembly. Most people will fare very well on such a diet, and the available evidence overwhelmingly affirms that.

We have a collective mandate to advocate for such a diet as the “general” best approach. There are no reliable data to suggest that diets based principally on meat and dairy could produce long-term health outcomes nearly so good, and abundant evidence suggesting the contrary. If, however, human health could be comparably advanced with plant-food or animal-food predominant diets, the imperatives of our time related to the global human population, the consumption of planetary resources, environmental degradation, and the abuses attendant upon “mass production” of animal foods- would argue mightily for plant-predominant eating as the default. Since the evidence regarding human health points emphatically this way as well, the argument becomes incontrovertible.

Within the general context of high-quality, plant-predominant eating- there is certainly room to accommodate human variation. Some people will best achieve satiety and weight control with the high volume and high fiber content of vegetables and fruits; others may do better with an emphasis on somewhat higher protein intake. There may be extreme cases, owing to genes we have yet to identify or other unknown determinants, that call for more radical dietary alterations- perhaps even the ketogenic diet (long used as therapy, by the way, for intractable epilepsy). There is no reason why such idiosyncratic needs cannot be satisfied, just as celiac disease requires the avoidance of gluten, peanut allergy requires the avoidance of peanuts, and lactose intolerance requires the avoidance of lactose in dairy. These do not alter the fundamentals of feeding Homo sapiens well; they just acknowledge that the importance of accommodating individual need.

We could have our high-quality diets, leading to high-quality health, and eat them, too, if we finally got around to placing the emphasis on wholesome foods in sensible assemblies, rather than propagating the failed distraction of macronutrient thresholds. Within the context of such high-quality diets, variations in dietary pattern to address intolerances, allergies, ethnicity, preference, appetite, satiety, and more- all readily find a home.

It’s National Nutrition Month 2021, and our food is, indeed, killing too many of us– both slowly, and during the pandemic- acutely as well. If you are worried about pernicious harms to your body, stop putting junk in your fuel tank- but by all means, do get a COVID vaccine when you have the chance. Let’s save the lions, let the lambs be, and begin the job of saving more than 500,000 of ourselves from premature death by dietary boondoggle every year.

With light burgeoning at the end of our pandemic tunnel, here’s to this month’s promise of cheer and froth. Just don’t swallow the usual malarkey.

-fin

This article was first published on LinkedIn.

Dr. David L. Katz     is co-author, with Mark Bittman, of How to Eat. He is a board-certified specialist in Preventive Medicine/Public Health.

Katz is the Founder and CEO of Diet ID, a company advancing an entirely new way to assess and personalize nutrition, and working to make “diet” the vital sign it deserves to be; and President of the True Health Initiative, a non-profit advancing diet and lifestyle as the best of medicine where science, sense, and global expert consensus meet.

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