With all the discussion of ultra-processed foods and healthy diets appearing in books and on the internet lately, I felt that I needed a refresher course in nutrition. I was interested in whether my knowledge of basic nutrition was still valid or if I had become hopelessly out of date. The last course in nutrition I had was over 40 years ago! With this thought in mind and in a moment of weakness, I signed up for one of the Great Courses–Nutrition Made Clear. I had seen their ads in magazines over many years for courses on all sorts of wonderful topics. I had wanted to try one. Notice of a flash sale came across my screen a few months back, and I jumped at the chance. In my mail shortly thereafter was a box containing six DVD discs, two transcript books covering 36 half-hour lectures, and a course guidebook with short summaries of each lecture.

Nutrition Made Clear is a series of lectures presented by Roberta H. Adang, RD, Director of Sports Nutrition and Clinical Dietitian, Baylor College of Medicine and Texas Children’s Hospital. What is more, she also worked as a dietitian for the Houston Texans. I found the written transcripts to be more informative than the video. It did not dawn on me until finishing several lectures to check on when it was published. It turned out that the course was over a decade old (2009). Much has changed in the field of nutrition since then. My response to her own words in bold:

“Total calorie needs are determined based on a number of factors, including basal metabolic rate, gender, age, muscle mass, exercise, and voluntary movement.” (volume 1, page 48) In a lecture titled “It’s All About the Calories!” I thought I was back in the 70s again. The importance of calories in weight maintenance has been emphasized in every nutrition course I have ever taken. Now many sources want to disabuse us of the importance of calories with respect to weight control. The ketogenic diet and protein leveraging may have some merit in their claim that it takes more energy for the body to process a protein calorie than other calories. For proteins to make a difference in weight loss or control, however, requires a severely imbalanced diet over a long time. For most of us, such issues do not apply. The nutritionists I follow still believe in calories.

“Fats are the most energy dense of all the macronutrients at 9 calories per gram.” (v. 1, p.122) Another concept that I was taught is verified here. Fats essentially pack twice the calories per gram (or pound) as carbohydrates and proteins. Nutritionists get the blame for scaring us away from fat, but I don’t remember them as the main problem back then. I was taught by them to be careful not to overconsume saturated fat such as that found in meat and cheese and not to overconsume calories from fat. The warnings to avoid fat or drastically cut back on fat came from MDs, food writers of popular books,  articles in the media, and marketers of low-fat products. Now we are bombarded by articles on good fats and bad fats with saturated fats frequently ending up as good ones. Hey writers, stop blaming the nutritionists and dietitians!

“It is most important to focus on food selection—more fresh, less processed, and less sodium laden food items. Keep in mind that another invaluable way of reducing your blood pressure is to increase your potassium intake by eating more leafy green vegetables, root vegetables, and fruits from the vine.” (v. 1, p. 219) This advice squares with dietary guidance both past and present, although I don’t remember as much pushback against processed food in that past as I hear today. My go-to textbook for nutrition, Understanding Nutrition, has come out against ultra-processed foods in the most recent edition, but it is very selective in identifying what foods are ultra-processed. Foods such as breads and fortified, high-fiber, non-sugared breakfast cereals are not mentioned even though they are also classified as ultra-processed.

Those products developed to meet specific nutritional or medical needs such as gluten-free or lactose-free items are recommended even though such items are clearly considered to be ultra-processed by the NOVA guidelines. Then there are plant-based meats and milks, which are also ultra-processed. Posts on my blog site by nutritionists and dietitians all seem to be concerned about processing or ultra-processing.

“For patients with high cholesterol and high triglycerides, diet and exercise play a key role in the prevention of cardiovascular disease.” (v. 1, p. 254) One series of television commercials I can’t stand features people who send off swab samples to learn about their genetic heritage. They find that they are part Irish, German, Italian or whatever and change their dietary habits due to health concerns in that particular population. A much more useful strategy is to rely on tests ordered by a physician to check out blood chemistry. Values out of range for any of these blood tests could merit dietary changes. Likewise, high blood pressure should signal concern about sodium intake. A highly restrictive diet in the absence of health issues or warning signs from blood tests, however, could have other adverse effects on one’s health or social interactions.

“Many consumers believe that food is medicine, and to a certain extent can be.” (v. 2, p. 160) The lecturer uses this statement to issue warnings about functional foods, and, to a certain extent, I think her concerns are warranted. It seems to me, that the phrase to let food be your medicine is usually code for introducing an unbalanced or untested diet. Many of the functional foods mentioned are formulated to meet nutritional or medical needs of specific groups of consumers. Such products can be a godsend to people struggling with nutrient deficiencies or food intolerances. When functional foods designed by Big Food or superfoods pushed by smaller companies are marketed to provide magical powers, then the buyer must be beware. In these cases, consumers are likely to become guinea pigs in an uncontrolled experiment.

“Both nutritive and nonnutritive sweeteners have very little evidence of detrimental long-term effects on overall health. Caution should be taken in childhood and pregnancy to avoid excessive amounts of nonnutritive sweeteners.” (v. 2, p. 207) Some of the most widely consumed functional foods are diet sodas. I typically consume two to five diet sodas a day, although I have given them up for Lent (more on that at the end of the month). Although sugar-sweetened beverages are described as one of the worst items found in the Western Diet, consumers seeking out a sweet, refreshing alternative are warned that artificially sweetened drinks are even worse. Nonnutritive sweeteners have been around since I was in high school—over 50 years ago.

Adang appears to give nutritive sweeteners (sugars) more of a pass than what I see in the form of dietary advice these days. She considers the problem with sugars to be primarily related to calorie control. Her advice seems to be that adults with weight problems are fine to consume products with nonnutritive sweeteners. Adults with normal weight can feel free to consume sodas with sugar. The cautions she proposes are for children and pregnant women. Abuse of caffeine, however, may be just as serious as abuse of either nutritive or nonnutritive sweeteners.

“The degree to which diet influences the balances between healthy and disease states may depend on the individual’s genetic makeup. Dietary intervention based on the knowledge of a nutrition requirement, nutritional status, and genotype can be used to prevent, mitigate, or possibly cure chronic diseases.” (v. 2, p. 259) Unlike many of the popular diets found in books or on the internet, dietitians take into consideration many factors when designing a specific diet for an individual. They generally do not resort to a one-size-fits-all approach. Particularly difficult is the design of a diet that must incorporate two or more sets of restrictions. Both Adang in this course and Patsy Catsos in The IBS Elimination Diet and Cookbook caution against adopting a vegan diet as it places additional restrictions on diet development. With respect to chronic diseases the author suggests that they are primarily related to too much food & too much of the wrong kinds of food (low nutrient/energy dense). She does not suggest that chronic diseases are directly related to food additives.

Assessment. Much of what is taught in this course squares with the nutritional principles I learned in my classes in the 70s. Adang does not have a particularly good grasp of food science including what is involved in food processing and in maintaining food safety. If she or anyone else updates this course, I suggest that these topics be either left out or presented by someone with a background in the area. Having said that, the book does not present processed foods in nearly as negative a light as many sources today. What has happened to the teaching of human nutrition in the last 10 years?

With respect to Great Courses, I was not nearly as impressed with the overall concept as I had been reading those magazine ads over the years. The content was good but somewhat outdated. I only viewed one of the 36 half-hour lessons, but it merely featured a talking head with few visual aids. I found the written form much easier for me to follow, but that may be that my mind wanders. I tend to multitask when watching a video. I should also mention that buying this course entitles me to daily emails letting me know about the great deals on other courses available. It doesn’t take that much effort to click delete.

Next week: Veganism: The Good, the Bad, and the Ugly by Erica Kenney