Eating's a Balancing Act A Sensible diet takes the worry out of what's good, what's bad

THE BALTIMORE SUN

Margarine is good. Margarine is bad. Milk is good. Milk is bad. What's a poor consumer to believe?

If you're among those alarmed and confused by conflicting advice on how specific foods affect your health, the word from a broad spectrum of health and food professionals is, don't worry.

That's right. Don't try to cope with complex epidemiological data, and don't get scared by scare headlines. There are only two things you need to know about food and health:

1. Eat less fat. A lot less.

2. Eat more fruits, vegetables and whole grains. A lot more.

"It's really that simple," said Roberta Klugman, executive director of the American Institute of Wine and Food, a nonprofit group dedicated to education and communication on issues of food and wine. "We say there are no good foods and no bad foods. All foods fit" in a balanced diet. "Some foods are better for you, and you eat more of those."

"Fear of food is not an effective health policy," said Dr. C. Wayne Callaway, an endocrinologist with 20 years experience in nutrition who is an associate professor at George Washington University in Washington. "It affects only a small percentage of the population and it's not a long-term strategy, it's a short-term thing, based on, 'Oh, what is the latest hazard today?' What we've found is that if you focus on the broad learning objective, you accomplish the secondary goals."

The fat-in-margarine issue is a perfect example, Dr. Callaway said. Instead of trying to sort out health claims for a particular fat or oil product, people should focus on balancing a "total fat budget," he said. "If you make the adjustments in your diet to bring fat down to less than 30 percent of calories, you automatically reduce 'bad' saturated fat to 9 percent to 11 percent, the recommended level." There's no need to worry about specific "good" and "bad" fats.

The standard recommendation is that people get no more than 30 percent of total calories from fat, though some experts say a level of 25 percent or even 20 percent would be better; most Americans currently get about 36 percent of calories from fat.

"People get very confused," Dr. Callaway said. "There's evidence of that and there's evidence of guilt. I've seen studies that show that 20 percent of the population have actually modified their behavior [in response to nutrition publicity], but there's another 50 to 60 percent who just feel guilty because they haven't made any changes."

Dr. Callaway, a longtime consultant to the wine and food institute, is participating in a public education initiative sponsored by AIWF and other food and nutrition professionals. The goal of the program, called "Resetting the Nation's Table," is to relieve people's fears and coax them back to the dinner table. The wineand food institute was founded 11 years ago by Julia Child, one of the country's most famous and most beloved cooks, and Robert Mondavi, whose Napa Valley winery is among California's best known, and others concerned that "food terrorists" (Ms. Child's phrase) were robbing people of their delight in food.

"We were very much afraid," Ms. Klugman says, "that the pleasures of the table -- not hedonistic pleasures, but the simple pleasure of sharing meals with family and friends -- were disappearing. The table was becoming a battle ground. And all the joy, the pleasure of earth's bounty, was being lost."

No one is arguing that diet and health are unrelated, only that public debates among researchers and media headlines that focus on a narrow aspect of medical or nutritional data may cause people to needlessly eliminate foods they enjoy or to cynically reject all dietary advice.

"The public deserves to know about these things," said Jayne Hurley, associate nutritionist for the Washington-based consumer group Center for Science in the Public Interest. "They can't wait for the 'definitive' study. But what I tell people who are sick and tired of being bounced around from study to study is that the big, major reports over the past few decades are amazingly consistent. If you stick with the basics -- eat less fat and more fruit, vegetables and whole grains -- you'll be fine."

Consumers Union survey

Indeed, when Consumers Union recently conducted a survey of 94 scientists, clinicians, registered dietitians and educators, it found among the 68 responses that "despite the many contradictions in nutrition research, the lines of evidence have converged to suggest an approach to eating that's consistent with overall good health and protection from a range of chronic diseases." The survey findings are reported in an article called "Eating Right, It's Easier Than You Think," in the October issue of Consumer Reports magazine.

In the article, Harvard epidemiologist Dimitrios V. Trichopoulos notes, "Although there is plenty of disagreement about what causes specific diseases, we all come to the same conclusion with respect to a healthy diet."

And that is: Less fat, more fish, far more fruits and vegetables, far more fiber. Sugar, salt, coffee and alcohol should all be taken in moderate amounts, less if you're at risk for heart disease.

The survey was undertaken, Consumer Reports says, to offer clear advice to consumers buffeted by the "crosswinds of scientific debate that blow through the popular news media."

One such gust, a report last week that trans-fatty acids -- a byproduct of the process of turning vegetable oils into solids, such as in the production of margarine -- may contribute to the risk of heart disease, rated front-page headlines in newspapers across the country. The New York Times called the finding "a stunning example of revisionist nutrition."

That phrase makes even the sober-sounding Ms. Hurley laugh. "No one ever said fat is good. If you want to reduce your intake of trans-fatty acids, cut back on fat. The nice thing about these foods" -- the trans-fatty acids are found in margarine and a wide range of products, mostly snacks and sweets -- "is that there are no-fat versions available."

Her concern is that the report "will make people go all the way back to butter. In fact margarine isn't as bad as butter, but fat is bad."

Science in the press

"There's too much science that's done in the press," said Dr. Peter Kwiterovich, director of the Johns Hopkins University's Lipid Research Center. A paper or a report comes out and is treated as if it were definitive, he said, but in fact one report or study or opinion does not make science. "But when you get a series of studies that all march together and all show the same thing [over a long period of time], that tells you something. That is reality.

"People should know what their cholesterol level is, they should know the levels of good and bad cholesterol, and of triglycerides [another fat element in blood]." Knowing those things helps people develop a rational "risk profile" that will help them make informed choices in nutrition and lifestyle.

"Clearly there are some foods that are better for you than others," said Dr. Mark A. Kantor, a food and nutrition specialist with the University of Maryland at College Park. "But as far as risk goes, diet is only one factor. It's important, but it's only one factor . . .

"One of the most important factors is family history. If cancer or heart disease runs in your family, a perfectly healthy diet can perhaps delay the onset of disease," but may not alleviate it entirely, Dr. Kantor said. "If you have a family where all the men have heart attacks in their 40s, someone who eats a very, very healthy diet may simply be delaying a heart attack to age 60."

The notion of a "perfect" food or diet is a persistent myth, Dr. Kantor said, citing the popularity of oat bran a few years ago. "People are always looking for the magic bullet. . . . In fact, diet is only one factor that can contribute to disease. What scientists are now finding is that exercise is extremely important -- far more important than anyone ever imagined." The benefits of even moderate exercise, perhaps half an hour three times a week, "are turning out to be enormous," he said. "People who eat all the right foods and then sit in front of the TV all day are just kidding themselves."

One problem in public perception is that the people who are reporting on food and health issues often "don't give the whole story," Dr. Kantor said. He cited the recent flap over milk, when a group of four doctors linked to an animal-rights group held a news conference in Boston to denounce consumption of cows' milk. "That was a group that really manipulated the media," Dr. Kantor said. "There was not one bit of new information -- they were just advocating their own agenda, to get people to be vegetarians."

Milk story was 'staged'

Dr. David Levitsky, a professor of nutrition and psychology at Cornell University, called the milk story "a staged exaggeration -- much of what they said is just not true on the basis of the data." But he noted the idea of whole milk as "the perfect food" is also a myth: It does provide calcium and vitamins, but it also has fat and cholesterol.

While the finding that trans-fatty acids may contribute to the risk of heart disease has a sound scientific foundation, Dr. Levitsky said, "I dare anybody to demonstrate that a margarine eater is going to have a higher risk of developing cancer or heart disease. Margarine is a small part of your diet and it's one of many factors" that contribute to risk.

"One of the problems is that risk has a distribution," he said. "There's a continuum of risk. But people like to think in terms of black and white. So you find young males who don't think anything can kill them, and they engage in very risky behavior. And you have young mothers who see a story about a risk in food, and they say, 'No, I'm not going to eat it.' "

The proliferation among perfectly healthy people of that notion -- "It's bad and I'm not going to eat it" -- drives Raymond Sokolov crazy. Health hysteria that targets particular foods is "completely insane," said the noted journalist, food historian and food columnist for Natural History magazine. "Modern fear of food is pseudo-scientific paranoia."

In an article in Allure magazine last December, Mr. Sokolov complained, "Fear of food is abroad in the land. Poison lurks on every plate. That is the message we hear from all sides. The message is often based on medical research -- fat is related to heart disease. But hordes of worried people are translating a nutritional statistic into a panic about almost every food in the larder." Mr. Sokolov quoted a message left on a "comments" card at New York's Union Square Cafe: "Welcome to the '90s! Get with the program and eliminate all butter, oil, salt, red meat, cheese, cream and sugar."

"Demands like these," Mr. Sokolov wrote, "are the public face of a private fear that's fed by the din of dietary scare messages put out by nutritional Jeremiahs."

"I think what happens is that people want to scare themselves into a better diet," Mr. Sokolov said in a recent telephone interview. "I believe that if you eat less and exercise more you may marginally increase the chances that you won't die of a heart attack." But the idea that the occasional ingestion of any specific food "is something that's going to contribute to your eminent demise is silly."

The Times story also perpetuated a misconception about diet and disease: "These oils . . ." it intoned, "may cause heart disease." Atherosclerosis, a buildup of fat deposits on blood vessel walls, is just one of the risk factors that contribute to an increase in the likelihood of heart disease (among others are hypertension, sloth, smoking, diabetes, predisposition and heredity).

'Good' and 'bad' dilemma

The whole margarine flap, Dr. Callaway said, "reflects the distortion that occurs when you start dividing foods into 'good' and 'bad.' . . . In a lifetime condition, like atherosclerosis, no single food is going to cause any disease. It's the aggregate, the total consumption over time that matters."

However, consumer advocates worry that health claims trumpeted in the media may encourage food producers and manufacturers to market or label foods in a way that is reassuring but misleading, if not absolutely false.

The Federal Drug Administration, which is expected to issue new food-labeling guidelines next month, is likely to have to decide at some point whether and how to list trans-fatty acids on food labels. The USDA study has not been published; until it is, the FDA can't consider its findings in any decision.

Labeling ought to give people "the tools they need" to make informed choices on food products, said Ms. Hurley, of the CSPI. "People think about food in terms of good or bad. Why don't we just help them choose foods that are good for them?"

CSPI would like to see "stoplight" labels: green for "foods that you can absolutely eat any time," such as skim milk, fruits, vegetables and whole grain breads; yellow for "sometimes" foods you can eat once or perhaps twice a day, such as sweetened breakfast cereal or frozen yogurt; and red for foods that should be eaten seldom, perhaps only once a week -- "foods with more than one flaw," as Ms. Hurley described them -- such as the typical hot dog, which is high in fat and contains undesirable chemicals.

"If you tell people what foods are the good ones, manufacturers will be encouraged to produce more of them," Ms. Hurley said.

Telling people that food is good is exactly what the wine and food institute has in mind, though it throw in jump line here plans to focus on foods that are "manufactured" in the diners' kitchens.

The group hopes that starting early will produce nutritional as well as social benefits; members are formulating a program for schools and community groups, tentatively called "Taste, Health and the Social Meal."

"One of the things we're moving toward is teaching children to cook, getting people back into the kitchen," Ms. Klugman said. "We're talking about quality of life."

That was exactly the sentiment expressed by Ms. Child at a seminarfor food industry professionals attending the Fancy Food Show sponsored by the National Association for the Specialty Food Trade, held in Washington in late July.

"I'm tremendously interested in having everybody learn how to cook," Ms. Child said, in her emphatic way. "It's a good way to teach children organization, and mathematics and so on . . . What better time to get together and talk over the events of the day? There's nothing nicer than communal cooking. You can share deep conversations while you're peeling potatoes.

"We must get back to the dinner table."

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