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Diet and Health: There, There and Getting There

Giving up favored foods involves the pain of heavy lifting -- trading up foods does not. But doing so either requires legitimate reformulations by food manufacturers, or our ability to make better choices among what's currently available -- or both.
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I am about to make the case that with regard to the profound influence of dietary pattern on health, we need to know both where there is, and have practical strategies to get there from here if we are to benefit. I believe our knowledge is more than ample in both cases, providing abundant opportunity to add years to life and life to years if ever we choose to get out of our own way.

There are two principal reasons for writing this particular column at this particular time. One is the publication of my commissioned article, "Can We Say What Diet is Best for Health?," just out in Annual Review in Public Health. The paper represents many months of work and provides my best effort at summarizing objectively what we do and don't know about food and human health.

The second is an exchange with friend, colleague, and health writer David Freedman, whose work is widespread, but tends in particular to grace the pages of the Atlantic. Mr. Freedman and I have a history of both friendship, and spirited exchange. In June of last year, he authored a piece in The Atlantic which either he or some editor entitled "How Junk Food Can End Obesity." I wrote a rebuttal of sorts, entitled "Bunk About Junk Food."

In fact, as our quite civil and mutually respectful exchange at the time revealed, Mr. Freedman and I agreed more than we disagreed. He was really saying that the practical strategy of trading up familiar choices to improved versions of themselves would be necessary for people to improve their diets, since admonishments to eat more fruits and vegetables over a span of decades have accomplished next to nothing. We agree entirely on this.

I was really saying that such trade-ups either result in food of genuine benefit, in which case it is no longer junk, or food that pretends to be better but really is still junk -- in which case it is of no genuine benefit, or as I've noted recently, the nutritional equivalent of lipstick on a pig. Mr. Freedman pretty much agreed with this.

Still, I am guessing he felt he owed me one since I picked the nit that began our last debate. This time, he did so -- suggesting that my emphasis on the dietary pattern that is best for human health might be a pie-in-the-sky distraction, and discourage people from making the incremental, step-by-step improvements in their diets that are more realistically within reach.

Since Mr. Freedman, who is unusually well read and very insightful had this impression, I was concerned others could as well. I have already let Mr. Freedman know privately how and why I disagree. Here, I am simply making the same argument public in the hope of forestalling other such misapprehensions.

Consider any given place you would like to be. Perhaps you would like to see the roof of the world from the summit of Everest. Or, perhaps you would like to bask in the sunshine on your favorite beach. Pick whatever you like. I trust we can agree that to realize your aspiration, two things are required: (1) knowing where there is; and (2) having the means to get there from here.

I simply contend that exactly the same is true of better eating for better health.

If we don't have a basic understanding that there is, indeed, a there, there -- and know where there is -- we are quite likely to set off in some wrong direction as we have done many times before. Worse, if we are focused solely on step-by-step progress without a clear sense of where we need to wind up, we make ourselves vulnerable to exploitation. For years, the food industry has willfully misinterpreted prevailing dietary guidance into the most profitable of distortions. No nutrition expert ever said "eat low fat, starchy, high-sugar, high-calorie cookies." But when we were fixated on low-fat eating, that's just what the food industry gave us. They have done much the same with every nutritional preoccupation to follow.

But that sort of thing can't happen when we know where we are going. For those who understood that advice to eat "low fat" meant less meat and cheese, more vegetables and fruits, Snackwell cookies were never much of a temptation, and certainly never mistaken for a panacea. Similarly, for those inclined to seek the benefits of prudent low carb dieting, low-carb brownies cobbled together out of miscellaneous junk are not much of a temptation -- but again, those looking at their feet and not clear on where they are going on vulnerable to the sales pitch for just such junk. Low-carb eating was intended to be about less starch and added sugar, more lean meats, nuts, seeds, and vegetables -- not the reinvention of brownies and cupcakes.

A basic knowledge of where we are going is required to avoid getting misdirected in the interests of someone else's interests, and at the expense of our good health. We have that basic knowledge. We are not clueless about the basic care and feeding of Homo sapiens. That basic knowledge is not in the form of some very specific diet, but rather a basic theme of healthful eating common to all of the diets that fare best in human populations around the world, in epidemiologic research, in intervention studies, and over the span of both history and pre-history. I have made that case many times in settings just like this one, and it's the very case I make in the new review paper. Whether low-fat or high, low-carb or high, with or without grains, with or without meat, with or without dairy; Paleo or Asian or vegan; Michael Pollan really did pretty much nail it: eat food, not too much, mostly plants.

Invoking my analogy, you certainly won't get to the top of Everest if you don't first head toward the Himalayas.

But now let's revisit Mr. Freedman's concern. Most of us who know where Everest is on a map have no hope of getting to the top, because we lack the skills and resources to do so. Mr. Freedman is quite correct that knowing where there is confers little benefit absent some reliable, practical means of getting there from here.

Getting to better health by adopting and maintaining a better diet is also a steep climb from the prevailing status quo, although thankfully far less daunting than Everest. It, too, requires far more than just a destination. It depends on the skills, strategies, and one step-at-a-time approaches that constitute a journey.

There are many such skills and strategies -- in fact, they fill the pages of my most recent book. Certainly Mr. Freedman and I agree that trading up food choices is among them. Giving up favored foods involves the pain of heavy lifting -- trading up foods does not. But doing so either requires legitimate reformulations by food manufacturers, or our ability to make better choices among what's currently available -- or both. I like both, and have devoted years of my life to developing programming to help move along both agendas.

My non-profit foundation offers a proven food-label literacy program, available for free, designed to help children and their parents trade up their choices. I led the development of a nutrition guidance system reaching some 30 million American shoppers at present, that is all about trading up choices in every category -- while also inducing manufacturers to make better choices available. The evidence is strong that it is doing both, although of course -- we have miles to go.

A clear destination -- whether a better dietary pattern for better health, the Mt. Everest base camp, or the place you want to spend your next vacation -- does not obviate the need for a step by step means of getting there from here. It is simply prerequisite. You can't get there without knowing where there is. In the case of diet, clarity about the destination is the only way to overcome the roadblock of confusion, bypass the recurrent follies of history, avoid the potholes of unintended consequences, and direct the cultural analogues of mass transit appropriately.

Such modes of transit from here to there are as essential to the mission as knowing where to go. Improving diet and health is not philosophy, it is a practical, pragmatic, real-world enterprise. It requires access, adaptability, accommodation, and incremental progress. People are no more likely to improve their diets in one fell swoop than they are to teleport to the beach. There must be opportunities to trade up food choices, improve recipes, and follow each step forward with the next.

Combining destination and route is the winning formula. When we do, and only when we do, will we indeed see a view from the summit of public health opportunity. When we do, a whole new world of possibility will spread out before us.


Dr. David L. Katz has authored three editions of a nutrition textbook for health care professionals. He is editor-in-chief of the peer-reviewed journal, Childhood Obesity, and President of the American College of Lifestyle Medicine.