Have we been misled by dietitians and nutrition experts into damaging diets because they have focused way too much on nutrients and not enough on foods? Can we blame these food professionals for the obesity epidemic we face as a country? The answer to both questions is Yes, contends Gyorgy Scrinis in his book Nutritionism. This concept has been echoed in numerous books that have been reviewed on the site including Vitamania, It’s Not About the Broccoli, The Microbiome Diet and Grocery. Pop nutritionists have told us to avoid processed food. Now some of them are beginning to tell us that everything we know about nutrition is wrong. Could this be the end of nutrition as we know it?
For those readers who have not read my recent book reviews, I have adopted a format of commenting on some selected quotations from the book. The selection of each quotation is not to serve as a “gotcha” response. Rather, I try to use quotes as a way of reacting to some key concepts that are being conveyed by the authors in their own words. I usually try to limit these quotes to just a few words, but Scrinis does not write concisely.
“Nutritionism—or nutritional reductionism—is characterized by a reductive focus on the nutrient composition of foods as a means for the understanding of their healthfulness, as well as by a reductive interpretation of the role of these nutrients in bodily health.” A criticism of modern science in all fields is that it tends to reduce its focus into its elemental patterns rather than looking at broader patterns. In nutrition, this practice means focusing on the role specific nutrients. Reductionist food science breaks foods down into its chemical components. The plea of Scrinis is that we need to focus on the food holistically and not on its component parts. Scrinis actually coined the term nutritionism, but Michael Pollan popularized it.
I concur that we should look at scientific findings more holistically to help place them in a broader context. It is reductionism, however, that has brought the great technological advances that we all have taken advantage of in medicine, transportation, digital communication and a host of other fields. Rather than trying to place discoveries in context and point out the unintened consequences that such advances inevitably uncover, practitioners of holism seek to attack the results derived from reductionism itself. I speak from some authority here as much of my research career was to apply a systems approach (a holistic endeavor) as part of an interdisciplinary team to the harvesting, handling and distribution of fresh fruits and vegetables. Although our efforts helped develop a better understanding of how produce gets to market from the field and how the process can be improved, we were never able to produce any major breakthroughs characteristic of the reductionists.
“These three specific forms or paradigms of nutritionism—quantifying nutritionism, good-and-bad nutritionism, and functional nutritionism—have framed scientific research, dietary guidelines, and food engineering and have defined how nutritional knowledge has been produced, interpreted, and applied.” Perhaps the most interesting and revealing part of his treatise is how he classifies the practice of nutrition science (labeled nutritionism) over the years. The quantitative aspects of research were most notable during the discovery of the role of vitamins, minerals and protein in the health of animals including humans. Contrary to Scrinis, quantification of nutrients is not a useless pursuit. Rather it forms the basis for most nutritional advances today.
I was never taught in any of my nutrition courses about good and bad foods. I was taught about nutrient composition, the benefits of specific nutrients and the problems associated with over-consuming certain nutrients. I was also taught that the biggest problem with fat is that it has twice the amount of calories per unit mass (weight) of protein and carbohydrate. I learned in these courses that the major problem with sugar is that it contributes calories while crowding out vitamins and minerals. The designation of good-and-bad foods comes primarily from the popularizers of nutrition—the food evangelists and pop nutritionists—NOT the dietitians and traditional nutritionists.
As far as development of supplements and functional foods, the blame goes to Big and Little Food and the food scientists who develop them. I am wary of foods that feature just one or two nutrients or others that promise health based on hype while glossing over the nutritional inadequacies of the product. I still believe in a balanced diet that provides sufficient nutrients without contributing too many calories or too much salt. Having said that I do rely on at least two functional foods—Benecol and Activia yogurt.
“Single nutrient deficiency diseases, for example—such as vitamin C deficiency causing scurvy—are now the exception rather than the rule in highly industrialized countries.” Such an argument is based on an all-or-nothing theory of deficiency disease. One either has a clear deficiency of vitamin C which leads to scurvy or has enough and is scurvy-free. Such a perspective begs the question if there is barely enough of a given vitamin or mineral in the diet to avoid a deficiency disease, is that person healthy? It does not allow for any subclinical problems lacking distinguishable symptoms that prevent optimal health. This concept has also been emphasized by Catherine Price in Vitamania. To learn about the effects of diet and specific nutrients on health, a nutrition researcher must be reductionist. Dietitians, however, take into consideration the information gleaned from the body of scientific research to become generalists in making dietary recommendations. We proceed down a proverbial slippery slope when we start to divorce nutrients from nutrition.
“The food quality paradigm ultimately involves integrating food production and processing quality, cultural-traditional knowledge, and sensual-practical experience, as well as the nutritional-scientific analysis of nutrients, foods, and dietary patterns.” To counter nutritionism, the author offers his “food quality paradigm.” Nutrients are considered in evaluating the quality of a food but not from a reductionist standpoint. It is a very tricky exercise, however, as Michael Pollan and Marion Nestle, two expected allies, are accused of practicing nutritionism themselves. Unfortunately quality is not clearly defined in his food quality paradigm. Foods are classified into six categories, primarily on the basis of how whole the food is, the number and type of ingredients, and how much processing/ reconstitution the product has undergone. Processed ingredients and chemical additives are major factors in downgrading the quality of a product. Strangely, no mention of interaction of foods with intestinal microbes is made. The popular view of the microbiome would appear to strengthen the author’s argument against nutritionism.
“Processed-reconstituted foods, on the other hand, are not merely foods that one should not overconsume but foods that one should avoid altogether, because they contain a high level of potentially harmful constituents and are otherwise largely devoid of nourishment.” Food scientists call these products formulated foods—more than five ingredients, some of which are difficult to pronounce. The tricky part of the reaction to nutritionism is how do we know if a food is “largely devoid of nourishment?” We used to be able to rely on the term “empty calories” which refers to a food high in sugar and or fat with few other nutrients. Nutritionism, however, suggests that a whole-wheat cereal containing no sugar or fat is not a form of nourishment. An apple or a bed of iceberg lettuce with a much lower vitamin and mineral portfolio would presumably be considered nourishing because they are representatives of fresh, whole, unprocessed fruits and vegetables. In addition, a homemade cake or cookie made from more than five minimally-processed, whole ingredients that do not sound like chemicals would escape the avoid-altogether list even if largely devoid of vitamins and minerals.
His prime example of the dangers of processed-reconstituted foods foisted us upon us by food companies and recommended by nutritionists is margarine, a major source of trans fats. Obviously, margarine, when made from partially hydrogenated oils, does not represent the best face of food science or dietary advice. These dangers are heralded on more than twenty pages in seven of the ten chapters in the book, however, but partially hydrogenated oils no longer occur as ingredients in processed foods. Few other examples are provided. Fortification of foods with synthetic vitamins also comes under attack. Ignored is the push to fortify and enrich foods after the Great Depression, which is largely credited with the disappearance of vitamin-and-mineral deficiency diseases like pellagra and goiter in the United States. If fortification is not such a good idea, should we return to dairy products and avoid the heavily fortified plant-based milks?
“Now the refrain of many nutrition and public health experts is that we ‘eat food, not nutrients’ and that dietary guidelines should therefore be food-based rather than nutrient-based.” If Scirnis is taken seriously, the long-term implications of his message could be ground-breaking. Cultural-traditional knowledge and sensual-practical experience would trump nutrient composition as a means of assessing the healthiness of a food or a diet. Fresh, local, natural, organic, pure, simple, and whole are terms that represent healthy food while added, artificial, chemical, lowfat, modified, reduced sugar, and processed signify ingredients and foods to be avoided. The problem with shifting the focus completely away from nutrients and to foods is that the body mines foods for its nutrients and not for their socio-cultural history. Today’s mantra is to avoid processed food. Will that change to avoid advice from dietitians and nutritionists? Will culture and our palate end up being our guide as long as it helps us avoid anything man-made? It seems that Nutritionism and the followers of Scrinis are urging us to answer yes to these two questions.
Bottom line. I confess to being alarmist on this topic. It seems to me that widespread adoption of this message will be the end of nutrition as those of us who have ever taken a college-level nutrition course have known it. Scrinis has thrown down the gauntlet in a very carefully conceived strategy. His vision is much deeper than that of Michael Pollan, but Pollan is the much better communicator. After a series of books telling us to eat food and not foodlike substances, it would appear that Michael Pollan is moving on to advance the use of LSD as medicine. It is imperative for those of us who believe that evidence-based nutrition is a viable pursuit of knowledge that we defend it.
Next week: A view from a nutrition educator on the changing face on nutrition