Food scientists are obsessed with shelf life. Food journalists are obsessed with healthiness. Shelf life relates to the longevity of a food product. Healthiness relates to the longevity of humans. Longevity is more than how long a product is fit to eat or how long a person is fit to live. Quality deteriorates in a food product. Quality of life deteriorates as we age. Food professionals look for ways to translate the healthiness of foods, meals, and dietary patterns into health-adjusted life expectancy. If only we could classify foods, meals and dietary patterns into healthiness. Why can’t we develop simple relationships to make us live longer, healthier? Or is this the modern equivalent to Ponce de Leon’s quest for the Fountain of Youth?
Life expectancy in the United States of America is declining. The simple explanation is that longevity is tied to health, and health is tied to our diet. Like most simple explanations, this line of reasoning has its drawbacks. Although everybody wants to live healthy for as long as possible, our daily activities, whether forced or voluntary do us in! Implicit in this line of reasoning is that Big Food controls our diet by filling us with ultra-processed foods. There are health trends in the USA that complicate matters. Deaths of despair plaguing white, middle-aged men from drug overdoses and suicide also decrease American longevity. Likewise, America’s youth die from automobile accidents, drug overdoses, guns, and suicides at much higher rates than many other countries around the world. Americans who reach the age of 75 outlive their counterparts in other wealthy nations.
But why let countervailing evidence destroy a popular theory that we all want to believe? That does not mean that diet has no influence on American health. What it does mean is that the link between diet and health with specific reference to ultra-processed food is oversimplistic. Classifying food, meals, or even dietary patterns as healthy or unhealthy may or may not improve longevity in the senior set. It is not likely to have any effect on deaths of despair or premature death in America’s youth. This week I take on the concept of healthy food, meals, and dietary patterns and their potential effects on life expectancy in the USA.
Healthy food may be a mirage. Fruits and vegetables are healthy, with vitamins, minerals, and dietary fiber with much less sugar, salt and fat than many processed foods. This construct assumes that some molecules in foods are healthy and other chemicals are unhealthy. Then again, fruits and vegetables don’t have much protein either. If we are smart enough, we can find plant proteins from different sources to make up for deficiencies of essential amino acids. Or do we need some protein from animal sources? And, some fruits like bananas, dates, and mangoes are high in sugar. Sugars in these fruits are bound not free and accompanied by dietary fiber. Does this make fruit sugars less unhealthy? Maybe, but aren’t sugars released in the gut during digestion. Fiber and fat slow digestion to prevent sugar spikes. Fiber is a good thing, but fat is not. Or is it that simple?
Whole foods have a reputation for being healthier than processed foods. Is that reputation deserved? Whole foods are contained in a matrix that permits slower digestion and greater nutrient interaction. Nutrient interaction in our cells is a good thing. Binding of nutrients by antinutrients is not a good thing. Nutrients in some processed foods such as cheeses also can be trapped in a food matrix and released slowly during digestion. This matrix can protect nutrients from antinutrients. Plant-based, whole foods are healthier than animal-based, whole foods. Or are they?
NOVA, a classification scheme emanating from Brazil, simplifies the evaluation. It divides foods into four groups—raw and minimally processed foods, processed culinary ingredients, processed foods and ultra-processed foods and drinks. The higher up the line, the more processed and the less healthy, or so it would seem. A careful look at ultra-processing reveals that it is more about the adding of chemical ingredients than actual processing steps. Now some of these added ingredients are highly processed, but the most highly purified ingredient, table sugar, is a culinary ingredient. It only becomes unhealthy when incorporated into an industrial formulation. The whole concept also ignores the extreme complexity of the chemistry of whole foods. And then there is the question of hyper-palatability. Are hyper-palatable foods the opposite of healthy foods? Can foods become too palatable for our own good?
Even a healthy food can lead to unhealthy practices if eaten to excess. NOVA classification does not quantify. A slice of whole-grain bread is ultra-processed and considered unhealthy. Five beers at a setting are not ultra-processed and not considered unhealthy.
Healthy meals provide the next level of healthiness. Meals combine nutrients in the form of multiple foods and can prevent eating any ingredient or single food to excess. Current thinking in healthiness favors home cooking over processing. White tablecloth restaurants provide healthier fare than fast food. Or so it would seem! Are these assumptions useful or do they also oversimplify healthiness? Home preparation can produce healthier meals if the preparer has a basic understanding of nutrition, but advice on the net is not always useful. Many prepared sauces and other ingredients used by home cooks are ultra-processed.
A home cook follows a recipe. Processors rely on industrial formulations. Both specify ingredients and a list of steps to be followed. Recipes measure ingredients by volume; formulations by weight. Home cooks are more flexible in their measures and less rigid in adhering to time, temperature, and other guidelines. Thus, the end result of a formulation is more consistent than that of a recipe. Most industrial ingredients rejected by NOVA are available for purchase by home cooks from Amazon. Sugar and salt are culinary ingredients when used at home but become objectionable when added in a processing plant. Upscale restaurants tend to have smaller portions than fast-food counterparts. Fast-casual establishments may rely less on fatty, fried foods, but they make up for it with large portion sizes and multiple courses. Rich desserts at any of these restaurants are not healthy options.
The healthiness of a meal combines the interaction of nutrients between different foods and dishes. Meals can provide balance not possible from a single food. The adverse effects of salty, sugary, fatty foods can be overcome by mixing with foods low in sugar, salt, and fat. Portion control and limited seconds help prevent excess calorie consumption. What really counts is not the healthiness of individual foods or specific meals. It is how foods and meals are incorporated into a dietary pattern.
Healthy dietary patterns are the ultimate object. Most dietary advisors allow for an occasional unhealthy food or even a fast-food meal on the run in an airport. It is the overall healthiness of what we eat daily over an extended period of time that contributes our personal health. Nutritional balance and consumption of a wide range of foods is desirable. Highly restrictive diets, even if loaded with healthy foods, may not be healthy choices in the long run. Two well-regarded patterns include the Mediterranean Diet and DASH. Recommended American dietary patterns tend to focus on the white culture and ignore minority preferences. A recent example is failure to classify rice as a healthy food even though it is a staple of many cultures.
Chemical obfuscation by food professionals does not help in communication with consumers. The idea that all chemicals are dangerous and do not belong in foods promotes misunderstanding. Such public messages are professional malpractice. It is the equivalent of yelling fire in a crowded theatre. An additive with a difficult-to pronounce name appearing on an ingredient list does not mean that it is a hazard. Familiarity with ingredients like sugar or salt does not mean that they are safe to consume in unlimited amounts. Certain consumers have sensitivities to both natural chemicals like lactose and synthetic ones like gluten*. Bias for natural molecules and against synthetic chemicals is not a good guide for maintaining health and safety.
In some circles fake ingredient lists are prepared for fresh fruits like bananas. They illustrate that fruits contain chemicals and that many of these compounds are difficult to pronounce. While the motive is good, such statements mislead on at least three levels. First, these are not ingredients but are chemical components. Everything we put into our mouths is chemical. Second, the list vastly undercounts the chemicals present in a fresh fruit. A detailed list of any fresh fruit would identify thousands of entries not the 30 or so that show up on these lists. Processed foods tend to be less complex chemically than whole foods. Third, fruit chemicals are unstable and undergo rapid changes. For example, the flavor of a baked apple is different from the flavor of a fresh one due to modification of many natural chemicals by heat.
Take home lesson. Most of us would like to live long, healthy lives. Not many of us wish to incorporate healthy foods, healthy meals, and healthy dietary patterns into our life plans. Rather than adapting healthy guidelines, we tend to feel guilty about the choices we make.
*Yes, gluten is a manmade chemical. Any cook or baker who adds water to wheat flour initiates the synthesis of gluten as natural wheat proteins glutenin and gliadin bind to each other.
Coming soon: Can a food be nutritious but not healthy?
11 thoughts on “Healthy foods, healthy meals, healthy dietary patterns”
Thanks for your comments. I agree with much of your perspective.
Interesting article on the complexities of defining “healthy” foods and dietary patterns for improving life expectancy. Despite the challenges of oversimplification, NOVA classification provides a helpful starting point. Ultimately, a balanced and varied diet over an extended period of time is key to personal health. Chemical obfuscation by professionals does not help in communication with consumers, who tend to feel guilty about their food choices.
Thank you for your comments. We disagree on the benefits or detriments of NOVA. It is an ill-conceived idea that does not have an appreciation of either how foods are processed or the chemical composition of foods. Dr. Monteiro who designed the classification system is neither a food scientist nor a nutritionist. His expertise is in public health. Ultra-processed foods are not about processing. They are about ingredients, mostly additives that are identified on food labels with chemical-sounding names. Caffeine has a chemical-sounding name, but it has been known as caffeine since before the label regulations were drawn up. Otherwise, it would need to be listed as trimethylpurinedione, or methylxanthine, or methyltheobromine, all chemical names for caffeine. Some ingredients added to ultra-processed foods are highly processed, but most of them are not. The most highly processed ingredient in ultra-processed foods is table sugar, but it is a culinary ingredient and not an ultra-processed one. The health warnings about ultra-processed foods are based on correlations between UPF consumers and specific diseases in large datasets. So many other factors are ignored. Such correlations do not demonstrate cause and effect, the standard for all scientific studies. What correlations do is point to a possible cause. To demonstrate a cause, scientists must develop a biochemical mechanism that explains the relationship between a substance and the disease. Then the mechanism must be tested. Such studies are very difficult to perform so people who believe that ultra-processed foods are responsible for most chronic diseases pretend that such correlations prove cause and effect. A recent study along these lines shows a strong relationship between eating meat and developing diabetes. Nothing in the scientific literature that I know anything about demonstrates how meat could cause diabetes. It doesn’t matter, guidance is now being given to stop eating meat to prevent chances of becoming diabetic. Maybe people who eat meat consume other types of foods or engage in other behaviors that do induce diabetes. All that I am saying is that NOVA and its classification of ultra-processed foods is not a useful starting point. I am all for “a balanced diet over an extended period of time.” NOVA does not provide that. It is more restrictive than helpful.
Hi Val, I like NOVA too. Not the end all and be all and some food activists have used the tool to make inflammatory accusations. But as a simple straightforward rule of thumb, getting more minimally processed intact Whole Foods on to the plate is a net positive.
Dietary patterns are what count. And in my opinion when we discuss healthy we need a more flexible approach to nutrients than is sanctioned by our dietary guidelines or FDA food label regulations. I can’t believe I’m saying this because I don’t approve of so many of their business practices, but I agree with Big Food that the current thresholds for our current axis of nutrient evil are too restrictive.
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I agree that we need to focus on dietary patterns. Healthy seems to be coming the new natural. It is a vague concept, but attempts to define it will only make dietary discussions more contentious. Your call for a more flexible approach to nutrients is welcomed, but I would prefer to work within the guidelines and label regulations. Finally, I would urge you to separate out food marketing from processed food products. Just because the former can be deplorable doesn’t mean that the latter are.
Actually, I see the FDA getting aggressive on labeling a food healthy for food product, grocery takeout pre-prepared meals, and for any website marketing. And in FDA jargon, there’s nothing vague about healthy.
The reason I put the Kiss ☠️ Test together was to develop an evaluation tool to document why this dietitian chooses not to follow the food rules. Palatable beats draconian threshold for sat-fat and added sugar at my table. One really interesting aspect to the new rules is when it comes to salt, most of my recipes don’t come close to the threshold now. FDA has cut back from 480mg/labeled serving and Big Food finds the new threshold draconian. But almost all my recipes actually clock in close to or significantly below the new threshold. I have evidence now to support cooking at home as a sodium reduction intervention.
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OK. I can see FDA policing the use of healthy in marketing of food products and pre-prepared meals. I think that you have done a nice job in your Kiss Test. With regard to sugar and saturated fat, healthy and palatable appear to be incompatible both in homecooked and processed foods. I wonder how representative your recipes are with respect to salt. Michael Pollan’s recipes are not within the guidelines I am sure.
There is much common sense yet responsible in this essay. I add the
critical observations that (a) people are biologically different, and
(b) how much (of anything) matters. You do mention the latter but I
want to support it as ultra-important.
We are used to clothing sizes, and with rare exceptions like some socks
and neckties, one size *doesn’t *fit all. Do you know your shoe size?
Probably yes, but most people probably don’t know their starch-sugar
conversion rate, nor their reaction if any to gluten, dairy (fuzzword)
or the protein mix in soybeans. It’s harder to measure these things
than shoe size, but we wouldn’t know how to use the data even if we had
them. (Yes, /data/ is a plural like /people/ which may surprise some,
like the synthetic nature of gluten surprised me.)
The public doesn’t all have choices, but those who do want
easy-to-follow rules as to healthiness, which are obvious but glaringly
avoided. Avoid extremes, eat a wide variety of foods, count and measure
(e.g., calories), self-discipline with pride, move around a lot, and see
and control your non-nutritional preferences, be they based on cost,
popular image, traditions or personal taste. Pop images are socially
powerful, and often unscientific. Not always, as dangers of too much
salt and sugar have become popular too, but following the images makes
you feel in control, you belong, even if the science-driven anti-miracle
minority says No.
What can you say to a fish-oiler who has very low cholesterol, and thus
unlikely to clog their arteries with other oils? Better to eat the
fish? No, they don’t like fish (taste, image, bones for some), don’t
have the time to prepare them, and the medicinal image of the fish oil
pill and even the Greek letter /omega /are positive. It’s even worse
(less bio-logical and more psycho-logical and socio-logical) for the
lipophobes, the fat-fearers, who use fat-free milk in their coffee, but
also love their fat-loaded high-protein main-dishes. Every bit counts,
they may say. And oil is better than fat. (Sometimes it’s the other
And the plant-animal conflict goes as far back as dinosaurs, but
cultural evolution is not biology-slowed and is visibly active today.
I don’t push bio-truths where they are resented and
poorly-absorbed/digested. There are real reasons why people fight
bio-logic, too much for here and already written, but not to be ignored
by anyone interested in this topic.
Allan Griff, Chem Engineer and Anthropologist
El Cerrito, CA 94530
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Thank you for your comment. Much of what you write expands on my thoughts. Wishing you well and a healthy, happy future.