Preventive Medicine Column

Dr. David L. Katz

Several decades ago, the food industry fooled us once by turning “reduce dietary fat” into an entire inventory of Frankenfoods unimagined by the scientists who first suggested we should eat less meat, butter, and cheese.  Low-carb proponents had this history lesson, and so should have seen it coming.  Instead, low-carb advocacy resulted in a whole new inventory of highly processed, high-calorie, nutritionally moribund “low carb” foods we may reliably believe Dr. Atkins never anticipated.  Déjà vu, all over again.

If this were just about history, there might be no need to care.  But it’s not; a diet of unintended consequences remains a clear and present danger.

Dr. Robert Lustig is arguing forcefully for the harmful – indeed, poisonous- effects of fructose in our food.  I have not heard him say “eat more artificially sweetened muffins,” but you can bet that’s just what the Muffin Man is hearing.

Dr. David Jenkins has pointed out the hazards of foods with a high glycemic index.  I don’t ever recall him suggesting we should eat more pastrami and fewer carrots- but some diets based on the ‘GI’ have pretty much done exactly that.

More recently, Dr. Jenkins and colleagues suggested that eggs were as bad for heart health as tobacco.  Leaving aside the very profound limitations of that study, and my disagreement with the authors about its implications and the health effects of dietary cholesterol, we can all agree the study did NOT say: “stop eating eggs, but keep the bacon and add donuts.”  Since America runs on Dunkin’, that response may be anticipated.  Unless Dr. Lustig’s advice is incorporated, in which case the donuts will be fructose-free.

We have abundant evidence that the “go organic” message can be corrupted; it never meant more nutritious.  We know that the good intentions of the “locavore” movement can run off the rails. A locally grown tomato in Minnesota in February could have a larger carbon footprint than one sent there from Japan!

Michael Pollan and Marion Nestle advocate, and rightly so, for a diet of foods direct from nature- but if the message ends there, it makes perfect the enemy of good.  Only 1.5%- yes, 1.5%!- of Americans are getting the recommended daily intake of both vegetables and fruits.  Advice that does not extend to improving the actual choices people are making among products in bags, boxes, bottles, jars, and cans may be perfect in principle- but of little real world use.

What is the solution?  It’s time to see the forest through the trees, and stop getting fooled, again.

We need dietary guidance that is explicit about foods people should, and shouldn’t eat.  Guidance that says once and for all “if it glows in the dark- whether it’s low in fructose or not; low in fat or not; low in sodium or not- step away from the box, and nobody will get hurt!”  We need to focus on overall nutritional quality.  We need to be more pragmatic, and less dogmatic.  And we need guidance that extends to the full range of food choices people actually make every day.  There are better chips, and choosing them matters.

In attempting to improve the American diet and health, I am in excellent company. But perhaps I’m more inclined to focus on the big picture than colleagues- or maybe I’m just more cynical.  I believe, given the least opportunity to do so, our society will replicate the profitable follies of our nutritional history.

The business of business is business.  If devising dietary concoctions that address the concern du jour keeps the customer satisfied and boosts profit, it’s rather hard to see why companies in a capitalist society would do otherwise.  The fault lies not with the rising stars of Wall Street, but with ourselves- for serving up such one-nutrient-at-a-time invitations to dietary debacles in the first place.

Our collective problem is not want of good intentions.  It is our failure to learn from the follies of history, and anticipate the enthusiasm with which industry elements will replicate them. Each time we come out with the next ‘one’ thing wrong with our food supply, it is another gift-wrapped opportunity for a marketing bonanza, and mountains of cash.

We have been living- and dying- for decades on a diet of unintended consequences.  We seem disinclined to digest the lessons of history and avoid perpetuating this pattern.  It will be a real shame if it goes on like this- because people will get sick, and die, unnecessarily as a result.  And since we have already been fooled more than once, this time around, the shame will be ours.




Dr. David L. Katz;