By Stephen T. Sinatra, M.D., F.A.C.C., F.A.C.N., C.N.S., C.B.T.
It’s no secret that a diet consisting of too much “junk” food or fast food can lead to obesity and other chronic diseases. Ultra-processed (unnatural) food may be tasty, but usually contains lots of refined sugar, saturated and trans-fats, and chemicals; it also generally lacks health-promoting ingredients like insoluble fiber, water and vital nutrients. As a long-term dietary choice, then, fast or junk food can be a prescription for weight gain and malnutrition. It can also engender silent inflammation, which is now thought to underlie chronic degenerative diseases like diabetes, cancer, osteoarthritis, and cardiovascular disease.
Simply knowing about these kinds of health risks may be enough for some people to change their junk food and/or fast food ways. However, for others, the convenience and affordability of fast and junk foods may be a way of life; it may be very difficult to break deeply ingrained dietary patters which started during childhood and are a part of a person’s family culture. Understanding the ultra-processed diet as a collective social problem, then, may help catalyze some of the widespread social changes necessary to combat today’s obesity and diabetes epidemics. For the vast majority of people, eating healthier is a matter of internal resolve combined with better availability and affordability of nourishing meals made from whole foods.In other words, change is more likely when it comes from external sources such as businesses and schools, as well as from within.
In “Technology, Diet, and the Burden of Chronic Disease,” David Ludwig, M.D., Ph.D., a pediatric endocrinologist and director of the largest pediatric obesity program in New England,discusses contemporary ultra-processed dietary trends within the context of three eras of food technology use. Rather than make today’s obesity crisis about individual overconsumption of the wrong kind of foods, Ludwig examines it from an economic and societal evolutionary perspective. In doing so,he helps lift away some of the stigma associated with obesity which may impede a person’s resolve to make health enhancing lifestyle changes. Ludwig’smultilevel approach to changing our unhealthy food trends involves metamorphosis at the government, industry, community, and individual levels.
Three Revolutionary Eras in Food Production
Ludwig characterizes the evolution of food technology within three distinct eras: the Paleolithic Era, and the Agricultural and Industrial Revolutions. In tracing how technological advances in food production during these eras got us where we are now, Ludwig does not suggest that we should abandon all technology and revert back to a subsistence farming lifestyle. Rather, he reminds us that with each progressive era came increased food safety, availability, digestibility, storage life, and transportability. Dietary improvements made possible by stone-age tools and fire, for example, helped support evolutionary brain development. Agricultural farming impelled civilization, and industrial methods created within the Industrial Revolution have become necessary to support the billions of people on our planet today.
Sometime in the past century, though, our business priorities began to run askew, implies Ludwig. Primarily fueled by short-term economic interests, we began to literally tip the scales of food production technology with mass produced goods made of concentrated sugar and refined flour. In the same light, we also began to start using toxic chemicals to grow our crops and cut dangerous corners in the way we raise livestock, such as standard use of antibiotics, artificial hormones, and feed additives which would make no one would want to admit “I am what I eat.”
Is it possible that residual growth hormones in dairy products and red meat could be causing humans to grow faster and larger too? With more than two-thirds of the American population overweight or obese, the need to start prioritizing public health when developing and utilizing technologies to facilitate food production has become painfully clear. The money saved on natural food production is now needed to pay billions of health care expenses associated with diabetes and obesity.
How Can “Comfort Food” Be So Bad?
Let’s face it, fast and junk foods are just tasty… and for good reason. They go down the hatch so easily because they’ve been chemically manipulated to taste good without bringing on a feeling of satiety. Additives and preservatives are not without their downsides, though. Monosodium glutamate (MSG), for example, which may be added to enhance flavor, is linked to increased risk of overweight and is an excitotoxin, i.e. it is toxic to brain cells. Ultra-processed foods also may contain hydrogenated (trans-) fats, which increase shelf-life but cause cellular damage due to oxidative stress.
Processed foods, like cookies, potato chips and white bread, also tend to be more calorically dense than foods more closely resembling Nature’s design. Ludwig attributes this to the fact that many processed foods have had water removed to help decrease transportation costs while increasing the shelf life. For people in refugee camps, this kind of food technology may be lifesaving. For those of us who simply can’t make the time, or otherwise lack the resources, to shop at farmer’s markets or grocery stores, an ultra-processed food diet may be life endangering.
Ultra-processed foods lack the minerals, vitamins, healthy fats, phytochemicals, and insoluble fiber found in fresh fruits and vegetables, which nourish our bodies and protect against heart disease and cancer – the very diseases diabetes and obesity increase our likelihood of developing! Fresh fruits and vegetables also tend to be lower in sugar and require less immediate insulin release for their digestion than processed foods. Chronic excess insulin release due to high sugar consumption can lead to diabetes and metabolic syndrome (characterized by weight gain around the mid-section).
Processed fruit and vegetable products, like blueberry toaster tarts or potato chips, give us lots of calories without providing much in the way of nutrition. Eating these foods here and there isn’t going to kill us; it’s when we live on them for long periods of time that we might become simultaneously malnourished and overweight, or even obese, depending on the portion sizes we regularly consume.
The Solution is about More than Individual Willpower
Obviously, the individual choices we make each day about what, and how much, we eat impact our state of health and weight. However, as Ludwig’s suggestions imply, true change that can reverse obesity and related chronic disease trends is necessarily a collective endeavor, requiring governmental, industrial, community and individual participation. All in all, Ludwig’srecommendations for developing and utilizing food technology which better serves public health involve revolutionizing the way we “supply” and “demand” food.
At the government level Ludwig suggests (1) restructuring agricultural subsidies to promote the supply of higher-quality, more nutritious foods, e.g. fruits, vegetables, and legumes; (2) establishing more regulation of food advertising and marketing; and (3) creating better funding for school lunch and other nutritional programs.
(1) Restructure Government Agricultural Subsidy Program:
Right now, our government promotes the production of processed food, as well as dairy and meat products. Such promotion is the indirect consequence of giving farmers monetary rewards for producing crops that eventually become animal feed or processed foods, rather than for producing fresh fruits, vegetables and legumes. As such, Ludwig implies that the government should take some responsibility for today’s obesity and diabetes health crises by making legislative changes that will support healthier public eating habits.
Each year, taxpayers are required to pay approximately $5 billion for farming subsidies – direct payments made to farmers for producing crops like corn, wheat, soybeans, rice, and peanuts; most ultra-processed foods are extreme variations of corn, wheat, and soybeans. Wheat and corn account for roughly 65 percent of all subsidies, and most subsidized corn and soybean crops are fed to livestock (which creates a whole new set of health risks for those who eat commercially produced meat, poultry and dairy products – a topic for a later discussion). Your tax money, then, also helps support the huge commercial farms, instead of the small farmers in America who struggle to compete against them; ten percent of farms – the largest and wealthiest ones – receive approximately 75 percent of all subsidies, while sixty percent of American farmers don’t receive subsidies at all.
Apart from sales (and access to federal crop insurance), what incentive do farmers have to grow fruits, vegetables, legumes, and healthy nuts like almonds and walnuts? Sheer, blissful knowledge that they are maintaining product integrity and not contributing to an ultra-processed society? What if lawmakers changed federal farm program funding so that producers of fresh, nutritious, and organically produced foods could be rewarded for providing healthy food? Taxpayers could then help fund the production of food that truly nourishes them and doesn’t contribute to skyrocketing health care costs associated with diabetes and obesity.
(2) More Regulation of Food Advertising and Marketing
Ever wonder why spokespeople for junk and fast foods tend to be cartoon characters? Anyone who has a child who relentlessly begs to go to a fast food restaurant that offers a particular toy with a kids’ meal, or only wants the cereal with the cartoon tiger, frog or bird on it has a pretty good idea. While characters that appeal to children are useful to get especially finicky children to eat, they also can help children establish unhealthy eating habits early on, and thus be more prone to chronic diseases earlier in life. With over one-third of all children in the U.S. overweight and 17 percent obese, there’s something to be said about changing the way junk food and fast food is marketed to children. Concerns about loss of speech freedoms aside, more government regulation of the advertising and marketing of foods that are linked to increased risk of diabetes in children may be helpful.
Some non-profit organizations have started taking matters into their own hands. Corporate Accountability International, the group that got Camel cigarettes to stop advertising with a cartoon camel, is currently campaigning to get McDonald’s to “retire the clown,” claiming that Ronald McDonald has too much influence over children. You can learn more about this Corporate Accountability International campaign atwww.retireronald.org/.
(3) Better Funding for School Lunch and Other Nutritional Programs
Until late December 2010, when Congress passed the Child Nutrition Bill (“The Healthy, Hunger-Free Kids Act”), federal reimbursement for schools providing school lunches had not increased in 30 years, despite inflation. It makes perfect sense that schools have cut corners and been serving cheaper, less quality, processed food over the past three decades. Designed to fight both childhood obesity as well as hunger, the Child Nutrition Bill provides for increased funding for school meal programs, better nutrition, and limits on the amount of processed foods available to children in schools. A step in the right direction, the bill’s passage demonstrates that children’s nutrition is climbing the ladder of national priorities. Hopefully it will pave the way for more reasonable, federal programs to help prevent obesity and diabetes down the line.
Government responsibility aside, Ludwig also suggests that, the schools take matters into their own hands by preparing lunches and snacks with whole ingredients rather than refined, processed goods. Additionally, he proposes that home economics curricula include teaching children to cook healthy meals. Such changes would also require community effort: action and dedication from school board members and parents.
In changing laws and regulations that affect the supply of food, either through measures that make healthy food more affordable or make junk and fast food less appealing to children and less cheap, the government indirectly helps individuals act preventatively. Other beneficial government action might include public service announcements designed to increase public awareness of the dangers of excess sugar and hydrogenated fat consumption.
To stay in tune with Congressional action that affects our food supply, visit the U.S. House of Representatives and U.S. Senate Web sites and/or contact your local Congress-people or Senators with comments and concerns.
At the industry level, Ludwig suggests boosting “the supply” of convenient, inexpensive meals made from whole foods as a way of getting people to choose healthier meals on a regular basis. With this comes an insinuation that, when given the choice between gourmet food and fast food, most people will choose the latter. Reading between the lines, it seems that “the easy,” “the fast” and “the cheap” have dominated both the “supply” and the “demand” when it comes to eating out in the U.S.
While individual consumers play a significant role in changing the “demand” – from food that is easy, cheap and fast to quality, healthy, sustainable and affordable –restaurants do need to do their part by making the “supply” better for us, i.e design menus that are not only affordable, but healthy. In addition to less processed ingredients, restaurants could help change obesity trends by offering healthier portion sizes.
Ludwig’s highlights Chipotle Mexican Grill, a quick service burrito and taco establishment, as a paradigmatic restaurant. Spend a few minutes on the Chipotle web site (www.chipotle.com), and you’ll see why. Check out “Food with Integrity,” a menu option through which you can learn about Chipotle’s commitment to providing quality, nutritious ingredients that support healthier and more sustainable use of food technology. Chipotle says its meals are comprised of “whole foods that are full of the nutrients and micronutrients that really keep your body running.” Whenever possible, the beef, poultry, pork, and dairy products Chipotle serves in its Mexican fare has been “raised with respect for the animals,” that is, without use of antibiotics, added hormones, or unnatural feed. The company also sources organic and/or local produce whenever possible from farmers “who focus on responsible and sustainable practices.” All in all, while not as cheap as the “food” at McDonald’s or Burger King, Chipotle’s menu items are designed to be nutritious as well as very affordable.
In citing the need for restaurants to start taking more responsibility for the health risks associated with the food they sell, Ludwig indirectly places emphasis on the power of demand. As suppliers of prepared foods, restaurants have the power to demand quality ingredients, and help shift food technology trends so that greater emphasis is placed on public health than on short-term economic gain. This, in turn, affects food manufacturers who can start marketing minimally processed goods like stone-ground bread, and use healthier preservation methods; Ludwig also suggests that manufacturers start designing healthier edibles.
Of course, a restaurant is only as good as its patrons, meaning that true change in “demand” must happen at the individual level. As we are literally becoming a super-sized nation of people, we need to start demanding that a “value meal” be more about quality than quantity.
At the public / individual level, Ludwig suggests that people (1) frequent restaurants that prepare meals from scratch; and (2) buy less ultra-processed food, and prepare more meals from basic ingredients in the home.
(1) Frequent Restaurants that Offer Wholesome Meals
Fast food may be cheaper in the moment, but the long term health costs can be monumental if eaten all the time. Do you remember the 2004 documentary movie, Supersize Me? In 2002, its director, Morgan Spurlock attempted to link excessive fast food consumption to obesity by solely eating at McDonald’s three times each day for 30 days. He would eat “super-sized” portions when offered to him, and ate everything on the menu at least once; he also did not exercise during this month. After 30 days, Spurlock gained 25 pounds and was experiencing heart palpitations. He noticed that he had become depressed and lethargic, and more headache-prone, and his girlfriend pointed out that his energy and sex drive were lower than before he started eating such high-fat, high-carbohydrate processed foods. In addition to describing his health deterioration, Spurlock also discussed how McDonald’s advertisements are targeted toward children who aren’t old enough to know what is (not) good for them.
There aren’t too many parents who can say that a McDonald’s playground hasn’t been a saving grace at some point or another. However, it is precisely this kind of convenience that traps us into buying the sub-par food that comes along with it. If we want to break free of diabetes and obesity trends, we have to be more conscientious about what and where we feed our children and ourselves. We need to seek out and frequent places that offer quality food designed to truly nourish us as well as promote satiety. Giving such places your business also helps send a message to other companies that a business model which promotes public health is possible to sustain.
(2) Buy Less Ultra-Processed Food
A surefire way to eventually shift public demand is to buy more natural and healthy food and less ultra-processed food. Over time, manufacturers will get the hint. As much as possible, shop at your local farmer’s market or co-op. You’ll help support the smaller farmers who don’t receive taxpayer money to indirectly produce more ultra-processed food.
Your best bet at the supermarket for healthy food choices is to stay as close to the periphery as possible; this is where the fresh produce and refrigerated dairy, poultry and meat products are usually found. As a general guideline, avoid foods packaged in boxes and plastic containers. Choose baby carrots, apple slices, cheese (skip the crackers), yogurt or nuts to have on hand for snacks, rather than potato chips, cookies, crackers or other sources of “empty calories.” Read labels, and be sure to choose organically produced or naturally raised products whenever possible. If the store you go to doesn’t provide organically produced goods, make the “demand” that it does.
Collective Change Begins with Individual Choices: Harnessing the Power of Public Demand
In a frustrating (yet perfectly legal) justification of the use of food additives that make up some of the 3,000 ingredients it regulates, the U.S. Food and Drug Administration (FDA) indirectly acknowledges the power of public demand:
“Our ancestors used to preserve meats and fish, added herbs and spices to improve the flavor of foods, preserved fruit with sugar, and pickled cucumbers in a vinegar solution. Today, consumers demand and enjoy a food supply that is flavorful, nutritious, safe, convenient, colorful and affordable. Food additives and advances in technology help make that possible.”
The more the public becomes aware of why processed foods should be eaten sparingly, or even reserved for emergencies, the greater the demand will be for healthy food. Store owners (and shareholders) who want to make money will then respond to this demand. With public health in mind, lawmakers hopefully also will respond to this demand, and take measures to promote a healthier supply of food. The less we, as a nation, demand faster, cheaper food (by not purchasing it), the greater the supply of healthier options we will eventually have.
References and Resources:
- Ludwig, D. “Technology, Diet, and the Burden of Chronic Disease,” JAMA(April 6, 2011)305;13:1352-53.
- Sinatra ST, Punkre J. The Fast Food Diet (John Wiley & Sons, Inc., 2006).
- He K, Zhao L, et al. Association of Monosodium Glutamate Intake with Chinese Adults: the INTERMAP Study. Obesity(2008)16;8:1875-80.
- Associated Press. “Farm subsidies not in sync with food pyramid.” Msnbc.com, August 11, 2005. Accessed May 2, 2011.
- U.S. General Accounting Office (GAO) Report to the Chairman, Committee on Agriculture, Nutrition and Forestry, U.S. Senate. “Farm Programs: Information on Recipients of Federal Payments.” GAO-01-606, GAO.gov, June 15, 2001.
- U.S. Dept. of Agriculture (USDA) Economic Research Service. Farm and Commodity Policypage. Accessed May 2, 2011.
- Environmental Working Group (EWG). “GOP Proposes to Cut Farm Payments.” EWG.org, April 5, 2011.
- Physicians’ Committee for Responsible Medicine (PCRM) “Health vs. Pork: Congress Debates the Farm Bill.” Good Medicine, Autumn 2007;16:4.
- The U.S. Food and Drug Administration (FDA) “Food Ingredients and Colors.” FDA.gov. 2010.
© 2011 HeartMD Institute. All rights reserved.