photo by donna turner ruhlman
Last spring, having damaged my knee, I called for an appointment to visit the doc. My usual internist was gone and so, providentially, his colleague Roxanne Sukol saw me. I say providentially because she has a great interest in how this country eats and in helping Americans become better informed amid so much contradictory information and harmful marketing in the media.
Dr. Sukol, who knew my work, launched almost immediately into descriptions of stripped carbs and insulin levels and omega 3 and 6 fatty acids, emphasizing that our national discussion should stop talking "healthy eating" and start talking "nutritious eating." She positively captivated me. As she attended to my knee, I asked to meet with her at a later date and subsequently wrote a short blog post about our conversation. "WE are HEALTHY," she told me, "if our FOOD is NUTRITIOUS." She subsequently sent me a piece on nutrition that she wrote for the Cleveland Clinic, where she is an internist and the medical director of the Wellness Enterprise at the Cleveland Clinic (she also writes an excellent blog, Your Health Is On Your Plate). The document, fully footnoted, is nothing short of a brief history of humans and eating, detailing how we got into this confused, dangerous mess we're in. It also serves as the first-ever chapter on nutrition in the Cleveland Clinic’s internal medicine text.
Several major changes in our food supply, Sukol writes, have resulted in our current epidemic of obesity, diabetes, and other chronic illness. Obviously the tidal wave of diet books and diet advice and fad diets hasn't worked, since the problems have only increased. Indeed, I'd suggest that diet books and trend diets may be a part of the cause. And I would heartily agree with her that everyone is so confused they don’t know what to eat anymore.
As we know, our food itself—its distribution, preparation, and consumption, all of it—has changed drastically in just the past hundred years, with an exponential acceleration during the past fifty.
"Prior to the 20th century," Dr. Sukol writes, "most Americans ate meals that they prepared themselves in their own homes. Today, in contrast, not only are the majority of meals eaten outside the home, but even meals eaten at home are often made elsewhere as well. For the first time in history, vast amounts of edible items are now being raised, prepared, and/or manufactured by entities unknown to the end consumer. Previously, meals consisted almost entirely of some combination of fruits, vegetables, legumes, nuts, fish, eggs, meats, poultry, whole grains, and dairy products, such as milk, cream, butter, yogurt, or cheese. Manufactured items such as corn syrup and partially hydrogenated vegetable shortening, for example, did not exist in the food supply at all."
Indeed, so much of what we eat today does not fall into any of the categories of what we used to eat, and what does is often heavily processed to replace nutritious elements (which can be costly) with inexpensive ingredients (refined wheat, many forms of sugar, salt, and cheap fats).
How and Why This Happened: Two Innovations That Solved a Single Problem
The explosion of processed food, from breakfast cereal and snacks to peanut butter and mayonnaise (that is, just about everything in the center aisles of your grocery store), became possible as a result of two innovations in slowing the rate at which fat becomes rancid, or fat oxidation. Once fat could be made more chemically stable, it could sit in warehouses, on trucks, and on grocery store shelves for much longer than it previously could—in some cases indefinitely.
"The first approach consisted of removing the oil-rich germ (as well as the brown, fiber-rich bran) from whole grains to make 'white' flour," Sukol writes. "The second approach involved a transition to the use of fats with a lower oxidation potential. This was achieved through either1) partial hydrogenation, which converted oil from a liquid to a solid state; or 2) selective and extensive use of omega-6 polyunsaturated fatty acids. These two developments increased shelf life markedly, and this, in turn, was the key to building the food industry."
Did you get that? Keeping fat from oxidizing by using ingredients that put our body out of whack was the key to building our current food industry.
Let’s look at a brief timeline leading up to these innovations:
Table sugar (sucrose), from sugar cane, likely originated in India and China and reached the Mediterranean basin between 800 and 1100 AD. By the 1400s, sugar was being exported from Italy to England. Demand surged with the introduction of tea and coffee.
Up until the late 1700s, all bread was chewy, dense, and brown. Then advances in gristmill technologies created a flour stripped of its bran, endosperm, and germ (the most nutritious parts) to make a “refined” white flour shipped to Europe and affordable only to wealthier families. To refine means to remove coarse impurities, but that’s advertising spin. It’s not refined in the sense of improved or made purer; it’s stripped of its natural wholesomeness.
By the next century, advances in technology and transportation lowered costs and allowed sugar and white flour to be distributed throughout the world. Economies of scale and government subsidies of raw materials increased quantities, further lowering costs. By the end of the 20th century, food composed of sugar and stripped white flour constituted the considerable majority of food available to us in stores and restaurants.
In 1957, another form of stripped carbohydrate was invented: high-fructose corn syrup. It was impossibly cheap and therefore of particular value to companies making shelf-stable baked food (bread, cereal, cookies, chips—just about everything in boxes and packages), condiments, and carbonated beverages.
All of this food, essentially carbohydrates stripped of the plant matrix that contained them, spikes blood sugars and increases the demand for enough insulin to deal with the sugar rush. Dr. Sukol likened this to a big party: You've got a limited valet service to park cars. If all of the cars (the sugar) show up to the party at once, this puts serious stress on the valets (the insulin) parking the cars. Insulin is the fat storage hormone, so the more insulin you use, the more efficiently you store the sugar as fat. If you don’t have enough insulin to catch all the sugar and park it in the cells, the sugar just floats around waiting for some more insulin to show up.
Obesity happens when you use lots of insulin, and diabetes happens when that large amount of insulin still isn’t enough to meet the demand. High insulin levels lead not only to obesity and diabetes, but also to high blood pressure, heart attacks, and all the other related chronic diseases that now cost $1 billion a day to manage.
This, in brief, is how we got here. Another critical ratio, concerning fat and the omega 3 and 6 fatty acids, is the other half of the nutrition equation. But for now, I'd like people to understand a truly simple way to keep our health and weight in check—without dieting, without counting calories, without latching onto fads—and it begins simply by avoiding foods that are not nutritious, namely, anything containing stripped wheat and sugar.
The bottom line, then: To maintain a weight that's appropriate for your body size (heavier or lighter depends on genetics; actual weight, how your body looks, etc., don't matter), avoid any products containing sugar or refined wheat, which is converted immediately into sugar in the body. Instead, eat carbohydrates that are contained within a fibrous matrix (that is plant material)—an apple, not apple juice; beans rather than pasta; animal protein (if you eat meat), plenty of fish; eggs!; natural dairy products (whole milk and cheese, naturally fermented whole-fat yogurt); and lots of green, leafy vegetables. You will be healthy because you are eating nutritious food.
If you liked this post, take a look at these links:
- My past posts on Dickson's Farmstand and Blue Hill at Stone Barns.
- A “major new study” supports the above.
- Michael Moss describes the rise of the processed food industry in his excellent book, Salt Sugar Fat.
- Keep up on new nutrition news in the health section of the New York Times.
- Calculate your BMI from the National Institutes of Health's website.
© 2014 Michael Ruhlman. Photo © 2014 Donna Turner Ruhlman. All rights reserved.
Another smart person affirming Michael Pollan's recommendation to ""Eat food, not too much, mostly plants." He defines "food" as vegetables, fruits, whole grains, and, yes, fish and meat and staying far away from "edible food-like substances."
Besides, real food just tastes so much better.
Michael I promise I learned this in Culinary school, 25+ years ago. Our Director, a talented chef that was also a RD, predicted the rise of diabetes, obesity, and heart disease through our infatuation with "pre-digested" foods.
This was a great read. I've been working hard to shift my mentality from " restrictive diet" to " abundant nutrition". I spend a lot of time developing dessert recipes that satisfy my sweet tooth without refined sugar or wheat. I'm not a raw-vegan (never!), but I find that raw vegan desserts are a great way to get a sweet kick without the offending ingredients. It's amazing what you can do with some nuts, dates and cocoa powder.
I also question the pervasive use of soy oil. It might be an improvement over all those transfats found in our crackers etc. But it is highly estrogenic and not easily digestible.
My other no, no, is sodium benzoate: It is used to retard fermentation. Our guts need fermentation for digestion. What's the point of eating saurkraut laced with sodium benzoate.
While I appreciate information like this, I find that boiling food down just to numbers and nutrition "strips" the enjoyment out of eating. I think that is a danger, too. There can be incalculable pleasure in a warm chocolate chip cookie or mulled apple cider on a crisp fall day. If I am sacrificing a couple of months at the end of life to savor those moments, so be it. (FWIW, I am healthy and active.) You'll pry my pie out of my cold, dead hands. 🙂
I don't disagree with you Darcie. You know I value pleasure above health! (Knowing full well that without health, little pleasure can be had.) I do think though that we need to think of that cider that cookie a big pasta dinner as luxuries rather than daily go-to foods.
@Darcie,
I don't think there's anything here condemning those foods you are referring to. I think it is a matter of two things:
1) Making those products out of the right ingredients,
2) Eating a moderate amount of those products.
That is, integrate a small proportion whole wheat flour, if you can, into your pastry dough. This isn't always possible for all pastries but it can be done. Make your own filling.
Use real fats in your pastry or cookie dough - Lard, Tallow, Butter. Those are real food things and work well in pastries of all stripes (using one, or a combination, depending on the type of pastry and your personal preferences)
Get GOOD chocolate, not the cheap stuff chock full of unnecessary additives.
Get GOOD cider preferably un-sweetened (so you can add a little if you really feel the need).
I think you can have your pie without deviating too far from what Michael and Dr. Sukol are saying. Don't buy frozen pie, frozen pie crusts, and cookies from a box. Make them yourself out of good things, and don't eat too much.
I so agree with you, Scottisloud!
I do make my pies from scratch (and view them and the cider as treats). But I stand by my assertion that most people writing about our terrible diets divorce themselves from how food also feeds our souls. I liken it to the war on drugs: the focus by experts is solely on the negative aspects and outcomes. Yet people continue to do drugs, because they realize the experts have been omitting half the story (drugs make you feel good). Since people feel they've been lied to, they discount the true-but-dire warnings of the experts. Likewise, people who focus only on the negative aspects of a bad diet and not the positive association people have with food are doomed to lose their audience.
I totally agree that we need to shift our focus away from "healthy" and toward "nutritious" or "nutrient-dense" food. Most Americans are starving for nutrients and that is the root cause of so many diseases. Our bodies need nutrition to synthesize hormones, repair cell tissue, keep blood sugar balanced -- basically, to do what our bodies are supposed to do. And we're feeding them empty calories and making ourselves sick by doing it!
Thank you for bringing Dr. Sukol to our attention. It's great to have someone employed by the Cleveland Clinic who will speak out about food issues.
Great advice. I'd add that the rise of GMO grains is a growing concern for me. I've recently found that US-produced wheat (largely GMO these days) causes problems for me (GI and skin) but I have no issues with it in Europe.
Jason - I'm sorry to burst the bubble on your hypothesis, but there aren't currently any commercially grown strains of GMO wheat in the U.S. (or anywhere in the world for that matter). You'll have to keep searching for the possible cause of the issues you're experiencing.
Steve-
Dr. Joseph Murray from the Mayo clinic directed an interesting study examining the blood of airmen who had been stationed at a base near Minneapolis in the late 1940's and compared with that of residents in the early 2000. He found a 4 times greater incident rate of celiac in the most recent group. That got me looking. Norman Borlaugh began experimenting with hybridizing grains in 1948 and by the year 2000 rolled around sources have estimated over 40000 varieties were created by wheat breeders. All in the name of providing more yield to feed the world's starving. From 1970's on they were aggressively damaging dna with x rays and gamma rays. Check it our for yourself. Look at an ag school like Michigan State, Penn State, etc. and check out their field trials. The only thing that they report on is potential yield not on grain quality or nutrition. After all, the wheat breeder's customer is the farmer and the farmer want as many pounds he can get from an acre.
There is a solution. Grains like einkorn, emmer and spelt all have hulls on them making them unattractive for breeders trying to maximize yield. They have been left untouched. These grains go back 10000 years and are legendary for their digestibility. Speaking for whole spelt flour: it makes amazing chocolate cakes, carrot cakes etc. Whole spelt pasta cooks in under 5 minutes and is 100% whole grain - every pound of kernels goes into every pound of flour. The ingredients? Whole spelt flour and water; can't get more natural than that.
Don
do you think kefir (if it's full-fat) is as nutritious as whole-fat yogurt?
yes
Michael - I appreciate your posts on how the food industry has evolved (and largely to the consumer's detriment).
The crux of the problem comes to the monetary incentive for food companies to continue using stripped ingredients (because they are cheaper) as well as consumer's monetary incentive (processed food is cheaper - perceived at least), time incentive (processed food is more convenient). and our natural addiction for sugar.
I'm very interested to hear your continued thoughts (and from other comments) on how we overcome these barriers to improve U.S. public health. I believe education is a large part of the answer, but who ideally does this come from (school systems, academics, non-profits, etc.)?
Keep up the good work that you do.
Another wonderful post. In the first few words, however, I thought a main point was to be that stripping leads to knee problems. Okay, shame on me for traveling there....
I read your first post on Dr. Sukol, and subscribed to her e-newsletter. Thanks for another rich resource, and for continuing to expand my horizons.
John K.
Akron, OH
I've taken to mixing high fat (10%) yogurt, almonds, kale, bananas, peaches, apples and strawberries in a Vitamix for breakfast. Any thoughts on how making a smoothie out of those ingredients would affect their nutrition?
Michael, how come you never mention the importance of exercise? It plays such a key roll in your health. I mean, while eating like you suggest may improve health it won't make you healthy without exercise. It is very possible to eat as you suggest and still be overweight, have high cholesterol, and metabolic syndrome.
kind of obvious, no? i didn't mention not smoking either. that said, exercise is critical to my own personal sanity and well being and the only reason I don't weigh 250 pounds.
Hi Michael, I like your passion and doctors getting on board with the importance of nutrition. In that regard, I'm sure you've heard the phrase "There is more than one way to skin a cat (or chicken or duck)". So, in my view it's very linear (linear is a form of logic that sees just changing the thing). The nonlinear approach (a form of logic that looks at the synergy of multiple influences) view is that we can also prevent the implication of insulin surges through the other foods within the meal. So do we HAVE to 1) only eat whole grains OR 2) can we be sure to eat the carbs with the proper synergy of ingredients to abate the insulin over-adaptations leading to diabetes etc.?
So two ways to skin a cat or two ways to buffer the impact of insulin. We can take out the offender (refined carb and make it complex) OR we can add foods that buffer the offender (like lycopene from tomatoes, antioxidants (wine), polyphenols or microbiotic foods). We CAN have some of these refined carbs IF they are in context with foods that provide a "healthy" balance for the "tax" or as she describes assist the valets to counter the overtaxing stress they may experience otherwise.
It is absolutely about this over-refining and shelf-life artificial sources of calories that are throwing the balance WAY off. But we can't throw the baby out with the bathwater here (by saying only whole grains will do) BUT it would be GREATLY advantageous to mix in some whole grains when possible (especially in other meals) and put a limit on the refined carbs we consume and get them from small suppliers that mill the flour on their premises (ideal) so it's fresh and germ oil (omega-3) intact.
Great conversations and continued considerations.
Cheers,
Lori
We live both in the US and France. One of the things that I find extremely annoying in the US -- it is almost impossible to find whole fat yogurt in the stores... there is abundance of 0 calory ones that taste like crap and obviously have no nutritional value... and water pumped anorexic bluish chickens, with no sign of healthy deep yellow fat under the skin... Don't take me wrong, supermarkets in France have plenty of processed crap too, but for every 3 types of 0 calory yogurts, there are 5 types of full fat ones :))
Natalie,
Make your own yogurt! New England Cheesemaking has about 5 strains. I use Y5 because it's not too sour. It takes about 30 minutes of active time and 4 hours to incubate. Chill it and add a scoop of your favorite jam. So much better than store bought. I have a photo tutorial I send to friends and family if you're interested. [email protected]. If that's not cool Michael you can delete me and reprimand.
Cheers! Kevin in the Pacific NW