Health, Nutrition and The Modern Diet

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Health, Nutrition and The Modern Diet

• Nancy R. Hudson, MS, RD
• Director, Dietetics Program
• University of California at Berkeley

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Characteristics of the Modern (US) Diet

• More meals (about 50) eaten away from home
• Often grazing replaces meals
• Consumers prefer foods which can be eaten on the
  go
• Meals eaten at home are largely manufactured, not
  home-cooked
• Taste drives food choices

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Other thoughts

• Cooking is going the way of other traditions like
  building homes and furniture and sewing clothing
• People cook less in designer, well-equipped
  kitchens than their grandparents did with a
  stove, a refrigerator and a set of pots and pans
• Cooking is becoming a hobby, not a necessity

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Changes in our Health

• Due to all of the following factors
• Changes in diet
• Advances in medicine and pharmacology
• Improvements in sanitation and food safety
• Changes in transportation

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Positive Effects

• We live longer than our ancestors life
  expectancy now 76.9 years
• More of us achieve optimal growth
• Fewer nutrient deficiency diseases
• Decline in infectious diseases
• Food supply is abundant though not always
  evenly distributed

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Negative Effects

• Obesity
• Osteoporosis
• Metabolic Syndrome
• Diabetes
• Some types of cancers

• Gastroesophageal Reflux Disease
• Cardiovascular disease
• Strokes
• Rates of these are declining

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Eating Disorders

• Though not necessarily related directly to the
  food supply, there is a relationship to the
  marketing of foods and the mixed messages of
• Eat all you want
• Thin is beautiful

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BIGFatProblem
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The Guideline

• Guidelines (until this month) were eat fewer
  than 30 of Calories from fat, no more than 10
  from saturated fat, at least 10 from
  monounsaturated fat, about 10 from
  polyunsaturated fat.. and, by the way, limit
  cholesterol to 300 mg. each day

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What the Public Heard

• Fat is bad for you
• Count fat grams, not Calories
• Dont worry about anything else

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What Industry Did

• Developed tens of thousands of low-fat or non-fat
  foods
• Found ways to make most of them taste good
• Marketed them as healthy food choices

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The Result

• Some people limited their fat intake, but
  continued to eat excess Calories
• The fat that was avoided was the fat could be
  seen, which was largely unsaturated
• The invisible fat, mostly saturated and trans
  fatty acids, continued to be eaten tipping the
  balance in favor of these unhealthy fats
• Outcomes included obesity and poor serum HDL/LDL
  ratios

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New Guidelines

• 20-35 of Calories should come from fat
• Saturated and trans fatty acids are unhealthy and
  should be limited
• Mono- and polyunsaturated fats have health
  benefits and are the preferred dietary fats

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It remains to be seen how this new message will
be popularized
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Problems with Nutrition Education

• The message is complex
• Attempts to simplify the message can actually
  lead to poor outcomes
• Over-reporting of single studies confuses the
  public
• Too many experts out there with differing
  opinions
• Headlines are often misleading

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Problems with Nutrition Education

• The message is complex
• Attempts to simplify the message can actually
  lead to poor outcomes
• Over-reporting of single studies confuses the
  public
• Too many experts out there with differing
  opinions
• Headlines are often misleading

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Some examples

• Historically, the Sippy Diet used to treat
  gastric ulcers led to cardiovascular disease
• The low fiber diet, previously used to treat
  diverticulosis, led to constipation and worsened
  intestinal disorders
• Avoid red meat can lead to copper, iron and
  zinc deficiencies

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More examples

• Count fat grams resulted in a disregard for
  energy balance and obesity
• Eliminate fat led to deficiencies diseases
  related to EFAs and some vitamins
• Eat organic can lead to the exclusion of any
  non-organic foods and, as a consequence, to a
  variety of nutrient deficiencies

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Problems with Nutrition Education

• The message is complex
• Attempts to simplify the message can actually
  lead to poor outcomes
• Over-reporting of single studies confuses the
  public
• Too many experts out there with differing
  opinions
• Headlines are often misleading

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Nutrition Action Healthletter (9/02)

• Fast Food 2002 -
• The Best Worst

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The Best

• Wendys Mandarin Chicken Salad
• Burger King Chicken Whopper Junior
• Subways Low-fat Subs
• McDonalds Fruit n Yogurt Parfait
• Burger King BK Veggie Burger

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The Worst

• Burger King Old Fashioned Ice Cream Shake
• Burger King Fries
• Burger King Hash Browns
• Burger King Double Whopper with Cheese
• Value Meals

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As reported by USA Today

• Nutrition Watchdog Praises
• Fast Food Giants

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• Two thirds of the column described the best
  fast foods in detail
• One third of the space was devoted to the
  worst it described only one of those foods and
  merely listed the other four

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Nutrition/Food Policy

• Should be based on science, not emotion
• Multiple constituencies need to be included from
  the onset
• The media is essential to the process
• Needs to develop slowly, examining all
  alternatives to prevent major errors from
  occurring

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Case in Point

• Local food policy goal is to promote the use of
  organic produce in schools and hospitals
• Propose to offset additional costs of organic
  produce by cost-shifting, i.e., charging
  specialty restaurants more for the product to
  subsidize its use in schools and hospitals

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Non-subsidized costs

• Labor for placing separate food order from
  additional vendor
• Personnel to receive additional delivery
• Cost of cleaning and preparation of produce
  (non-organic is usually table ready)
• Additional costs for processing accounts payable
• Product shelf life may be shorter
• Less marketable appearance of some products

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Food Policy that has worked

• Iodization of salt
• Fortification of milk with Vitamin D
• Enrichment of cereals and grains (including the
  recent addition of folic acid to prevent neural
  tube birth defects)

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Industry-driven Change

• The industry will change if consumers demand it
• It will also change if there is a marketing
  advantage
• Sometimes responding to the health needs of the
  population has a long-term advantage
• Its OK for industry to be profitable

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Industry-driven Changes that have worked

• Fortification of orange juice with calcium
• Removal of lard from General Mills Bisquick
• Removal of lard from Nabiscos Oreo Cookies
• Campbells Healthy Request Soups
• Brands like Lean Cuisine and Healthy Choice

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Oil Change at McDonalds

• Not a panacea
• Addresses the type of fat dilemma
• Ignores the amount of fat dilemma
• Many of my colleagues say it is not enough
• New oil has long-term potential to alter the
  serum HDL/LDL ratio for the better, for those who
  frequent McDonalds

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Hidden Costs

• New type of oil is more expensive (though
  probably not significantly for such a large user)
• Oil has lower smoke point thus needs to be
  changed more often, so both labor and raw
  material costs increase
• Since cooking oil cannot be discarded, the
  recycling of more used oil also adds to the total
  cost

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The message of good nutrition is not simple

• Adequacy
• Balance
• Moderation
• Variety
• Caloric Density
• Get Moving!!!

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In conclusion

• I believe that we are moving in the right
  direction and that partnerships between food and
  nutrition scientists, dietetics practitioners,
  industry, and the government will facilitate
  progress, not inhibit it.