Archive for March, 2012

Michael Pollan and John Harvey Kellogg

Michael Pollan argues in In Defense of Food that Americans’ susceptibility to food fads is nothing new. To make his case, he tells of Dr. John Harvey Kellogg and Horace Fletcher. Dr. Kellogg ran the Battle Creek sanitarium, where, Pollan explains,

[P]atients (who included John D. Rockefeller and Theodore Roosevelt) paid a small fortune to be subjected to such “scientific” practices as hourly yogurt enemas (to undo the damage that protein supposedly wreaked on the colon); electrical stimulation and “massive vibration” of the abdomen; diets consisting of nothing but grapes (ten to fourteen pounds of them a day); and at every meal, “Fletcherizing,” the practice of chewing each bite of food approximately one hundred times…Horace Fletcher (aka “the great masticator”) had no scientific credentials whatsoever, but the example of his own extraordinary fitness…was all the proof his adherents needed.

While I think it’s important to distinguish between sound science and food fads dressed up with scientific words, nothing I could say on this topic could compare to the ideas in a comment posted on the local news site Berkeleyside last summer by commenter Bruce Love. With a few spelling corrections, here is Bruce Love’s comment:

Are Pollan and Kellogg all that different? It’s a question that Pollan invites by criticizing Kellogg.

Kellogg, in some sense, got famous and influential by assuring rich people that: Affluent people were smart and superior to others to spend more money on diet issues than most could afford to spend. Kellogg was happy to get a taste of that spending. He assured the affluent that the typical food most affordable to and consumed by hoi polloi was morally inferior when chosen by anyone who might be able to sacrifice to avoid it. He offered that pursuing these newly coined food values for a hedonistic outcome of bodily pleasure was a political and religious virtue. He allowed that a masochistic element to his program of eating and other regimens was proof of its moral superiority. And finally he held that by pursuing these dietary values, one was actually bringing about a transformative improvement to society and the world at large.

So for Kellogg’s followers, you had a dash of self-flagellation, a sense of moral superiority, a valorization of conspicuous consumption, a messianic narrative, a false elitism, a false identification of one’s bodily sense of well-being with one’s political virtue….

Whereas, from that perspective, with Pollan…you have exactly the same thing with fresh curtains. Instead of Kellogg’s god in the equation you have a faith-based interpretation of traditional culture. Instead of a narrative in which science enables the perfecting of diet, you have a narrative in which science currently proves mainly its own limitations in diet design. Instead of services sold at the Sanitarium, you have farmer’s food boutiques, lifestyle small farming for an affluent customer base, and books and lectures.

I’ve very little doubt but that Pollan’s eating advice and notes on the supply chains are vastly better than anything Kellogg had to offer. I’ve very little doubt that many of his fans have had their lives objectively improved by their exposure to Pollan. Maybe his program even does some kind of good in the world — I hope so but I have my doubts. Nevertheless, the negative reactions are easy to understand when you see that the most visible evidence of his reception by the general public more closely resembles a slight update to Kellogg than it signals the dismissal of the social dynamic that gave Kellogg such influence.

I’m not sure I agree that Pollan would admit any “masochistic element” to his dietary philosophy or that Kellogg’s program could reasonably be described as “hedonistic.” However, I do think that the point about the reception of the two dietary philosophies is insightful. While I have known many of Pollan’s fans who were sincere in their concern for the environmental and health issues of which Pollan writes, there have also been those who seemed most interested in the conspicuousness of their consumption. With this in mind, it seems fair to discuss the possibility that Pollan is another of the food faddists whom he decries.

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Dietary advice, nutritionism, and marketing

Michael Pollan discusses Americans’ dietary changes in the aftermath of the publication of the Dietary Goals for the United States:

For while it is true that Americans post-1977 did shift the balance in their diets from fats to carbs so that fat as a percentage of total calories in the diet declined (from 42 percent in 1977 to 34 percent in 1995), we never did in fact cut down on our total consumption of fat; we just ate more of other things…Basically what we did was heap a bunch more carbs onto our plate, obscuring but by no means replacing the expanding chunk of (now skinless white) animal protein sitting there in the middle.

How did that happen? I would submit that the ideology of nutritionism deserves as much of the blame as the carbohydrates themselves do–that and human nature. By framing dietary advice in terms of good and bad nutrients, and by burying the recommendation that we should eat less of any particular actual food, it was easy for the take-home message of the 1977 and 1982 dietary guidelines to be simplified as follows: Eat more low-fat foods. And that is precisely what we did. We’re always happy to receive a dispensation to eat more of something (with the possible exception of oat bran), and one of the things nutritionism reliably gives us is some such dispensation: low-fat cookies then, low-carb beer now. It’s hard to imagine the low-fat/high-carb craze taking off as it did or our collective health deteriorating to the extent that it has if McGovern’s original food-based recommendation had stood: Eat less meat and fewer dairy products. For how do you get from that stark counsel of the idea that another carton of Snackwell’s is just what the doctor ordered? (50-51)

I’m not convinced that Americans tried particularly hard to follow the low-fat dietary advice. After all, Pollan chronicled in The Omnivore’s Dilemma the rise of fast food over roughly the same period, even claiming that there’s no animal flesh in nature with as much fat as a chicken nugget.

My main point in writing, however, is to call into question Pollan’s argument that the focus on nutrients made it particularly easy for us to take dietary advice the wrong way. If McGovern’s original advice, to eat less meat and fewer dairy products, had stood, it could have been simplified to “Eat more dairy-free and meatless foods.” Nabisco could have given us dairy-free Snackwell’s (no doubt loaded with hydrogenated vegetable oils), and fast-food chains might have given us breaded vegetable protein instead of chicken nuggets. Thus, the idea that a focus on nutrients makes dietary advice particularly prone to co-optation by food companies is not nearly as obvious as Pollan would have us believe.

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Some corrections and clarifications

Last Friday, while working on my last entry, I came to the realization that two sentences in my piece in the Berkeley Science Review in September were not quite right. These sentences contained a number of claims which were either subtly wrong, misleading, or which simply could have been expressed more clearly.

The sentences in question came in my response to Michael Pollan’s assertion that “the dietary advice enshrined not only in the McGovern ‘Goals’ but also in the National Academy of Sciences report, the dietary guidelines of the American Heart Association and the American Cancer Society and the U.S. food pyramid bears direct responsibility for creating the public health crisis that now confronts us.” I wrote,

However, McGovern’s Goals called for a substantial reduction in refined carbohydrate consumption and an increase in consumption of carbohydrates from fruits, vegetables, and whole grains. Americans collectively disregarded both of those recommendations, as well as a recommended decrease in daily energy intake.

These sentences have since been corrected. Here’s what I think deserves correction or further explanation (all data on historical consumption of foods are from USDA loss-adjusted food availability data):

  • George McGovern’s Dietary Goals for the United States didn’t directly call for a reduction in consumption of refined carbohydrates (which includes both refined grains and added sugars). The first edition (published in February 1977) called for a forty-percent reduction in sugar consumption. The second edition (published in December of the same year) called for a forty-percent reduction in consumption of refined and processed sugars. This means that it would have been consistent with the advice to replace added sugars with white flour. However, that isn’t what Americans did; they increased their consumption of both refined grains and added sugars. Consumption of added sugars did decrease somewhat as a percentage of total calories after 1977, but not by the 40% recommended by the Goals.
  • The Goals left some ambiguity over whether whole grains should be preferred to refined grains. The document listed among a set of “Changes in Food Selection and Preparation” the recommendation to “[i]ncrease consumption of fruits and vegetables and whole grains.” However, later, under the heading “Guide to increasing complex carbohydrate consumption,” the document noted that “there have been no studies that have found whole wheat flour to be superior nutritionally to white flour when consumed in a normal diet, and surprisingly few studies have even considered the question.”
  • The recommendation regarding total calorie consumption was found only in the second edition of the Goals. Moreover, that edition didn’t tell everybody to reduce calorie consumption. Instead, it made the recommendation to those who were overweight, and advised the general population to “decrease energy intake and increase energy expenditure.” Most likely, if this advice had been followed it would have resulted in a decrease in energy consumption per capita. However, if I were writing the piece today, I probably would have said that Americans “ignored a warning to avoid excessive caloric intake.”
  • Total consumption of fruits and vegetables actually increased slightly in the years after the publication of the McGovern report. However, the percentage of total calories from fruits and vegetables decreased. The Goals typically called for increases or decreases as a percentage of total calorie intake, so I think it is fair to say that the recommendation on fruits and vegetables was not followed. However, the word choice could have been more clear. Unfortunately, I was not able to find data on consumption of whole grains, but consumption of grains increased substantially. (Pollan claims in In Defense of Food that most of the increase was in the form of refined grains.)

While I should have been far more careful in writing these two sentences, I think that the point I was attempting to make was sound. Namely, considering that substantial parts of the dietary guidelines were not followed, it doesn’t make sense to blame the guidelines for health problems that have resulted. That said, it’s important to get the details right, and I should have been more careful. I’ll try harder to do both of those in the future.

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Dietary fat, weight, and the importance of context

In arguing against the low-fat campaign, Michael Pollan cites extensively a review out of the Harvard School of Public Health. The review focuses on the relationship between dietary fat and coronary heart disease, but it also addresses the supposed connection between low-fat diets and weight loss.

As Pollan tells it,

One other little grenade is dropped in the paper’s conclusion: Although “a major purported benefit of a low-fat diet is wieght loss,” a review of the literature failed to turn up any convincing evidence of this proposition. To the contrary, it found “some evidence” that replacing fats in the diet with carbohydrates (as official dietary advice has urged us to do since the 1970s) will lead to weight gain. (45)

The official dietary advice, instead of promoting weight loss, would lead to weight gain. Damning, isn’t it? But as is too often the case in Pollan’s writing, the actual study tells a more complicated story. Here’s what the review says:

A major purported benefit of a low-fat diet is weight loss. But long-term clinical trials have not provided convincing evidence that reducing dietary fat can lead to substantial weight loss. On the contrary, there is some evidence that a diet containing a high amount of refined carbohydrates may increase hunger and promote overeating, which can lead to weight gain and obesity. It is now generally agreed that total energy intake, whether from fat or carbohydrate, relative to energy expenditure, is a more important determinant of body weight than dietary fat per se.

You’ll notice that the review quite specifically implicates refined carbohydrates like sugars, white flour, and white rice as a cause of weight gain. As it happens, these were not the kind of carbohydrates that the official advice told us to eat. Senator George McGovern’s Dietary Goals for the United States encouraged Americans to decrease consumption of sugars and increase consumption of fruits, vegetables, and grains. The National Academy of Sciences’ Diet, Nutrition, and Cancer did not make an explicit recommendation with respect to refined carbohydrates, but it specifically recommended accompanying the decrease in fat intake with an increase in consumption of fruits, vegetables, and whole grains.

Pollan is correct to say that official dietary advice encouraged Americans to replace fat with carbohydrates. His claim that the review implicates carbohydrate consumption in weight gain is more of a stretch, but perhaps still arguable. However, when he puts these claims together to argue that the review claims some evidence that would link the official dietary advice to weight gain, he misses the mark badly.

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The Atkins diet and the “American paradox”

Michael Pollan suggests that rather than talk about the “French paradox” we ought to confront the “American paradox” which he defines as “a notably unhealthy population preoccupied with nutrition and diet and the idea of eating healthily” (9). We’re to make a connection and believe that our preoccupation with healthy eating is making us unhealthy.

The evidence he provides for for this, however, leaves much to be desired. As I wrote at the Berkeley Science Review blog, Americans didn’t follow much of the dietary advice which Pollan argues “bears direct responsibility for creating the public health crisis that now confronts us” (60). (James McWilliams has also pointed out that Pollan even refers in In Defense of Food to Americans’ increasing consumption of junk food when it suits his point.)

One piece of evidence which Pollan brings to the discussion underscores the limitations of his argument. He tells us that “when the Atkins diet storm hit the food industry in 2003, bread and pasta got a quick redesign (dialing back the carbs; boosting the proteins) while poor unreconstructed potatoes and carrots were left out in the carbohydrate cold” (38).

A tendency to go on weight loss diets is hardly evidence of an obsession with healthy eating. Attempts to lose weight are often motivated more by aesthetic concerns than health concerns, a distinction made particularly clear by the case of the Atkins diet, which many doctors and dietitians warned was unhealthy. Moreover, even when motivated by  health considerations, a weight-loss diet is an attempt to change an existing condition which is perceived to be a problem. Pollan seems to want us to identify the diet as the cause of the problem, which gets the chronology backward. Although Julie Guthman has argued that we need to look beyond food to understand obesity, to the extent that food is to blame, it seems more plausible that the problem lies with the soft drinks, fast food, and other junk food that were the villains of The Omnivore’s Dilemma.

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Butter is a processed food

In explaining the appeal of nutritionism to food processors, Michael Pollan tells the story of margarine, which “started out in the nineteenth century as a cheap and inferior substitute for butter, but with the emergence of the lipid hypothesis in the 1950s…could be marketed as better–smarter!–than butter” (33).

Margarine isn’t a bad example for building a case against nutritionism; it’s probably the best one there is. While I think that Pollan somewhat overstates the role of nutritionism in pushing margarine into the mainstream (mainly by understating the importance of wartime butter shortages and lower prices to margarine’s success), it has become sufficiently clear that the nutritional establishment erred in recommending that Americans consume trans fats.

With that said, there’s a certain irony to the way in which he contrasts it with butter. When he explains that margarine is “the product not of nature but of human ingenuity” (33), it is worth pointing out that one doesn’t simply find butter in nature, either. Butter is, of course, produced by separating the fat out of cow’s milk.

Now, most food is processed in some way, and one might argue that the process of producing butter is one that has proven itself over time. However, in The Omnivore’s Dilemma, Pollan explains the problem with processed foods in a way that makes it hard to give butter a pass:

Natural selection predisposed us to the taste of sugar and fat (its texture as well as taste) because sugars and fats offer the most energy (which is what a calorie is) per bite. Yet in nature–in whole foods–we seldom encounter these nutrients in the concentrations we now find them in in processed foods… (106)

Thus, butter, as a concentrated fat, exemplifies the problem that Pollan identifies with processed foods.

The point here is not about the healthfulness of butter (I’ll leave that question to the nutrition researchers and dietitians) but the shallowness of Pollan’s discussion of food processing. Pollan will later suggest that we should “entertain seriously the proposition that processed foods of any kind are a big part of the problem” (141). Yet he frequently mentions butter in a positive light, never mentioning how it comes to be. It’s a remarkable lack of nuance for somebody who claims to be arguing against a Manichaean ideology.

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Does nutritionism preclude pleasurable eating?

Michael Pollan devotes a chapter of In Defense of Food to defining the notion of “nutritionism,” which we’re to distinguish from nutrition. Whereas the latter is a scientific discipline, the professor of journalism explains, “As the ‘-ism’ suggests, [nutritionism] is not a scientific subject but an ideology.” This ideology rests on the premise that “Foods are essentially the sum of their nutrient parts” and several other premises which flow from this first one.

Pollan argues that because we can’t see nutrients, in the nutritionist view, “it falls to scientists…to explain the hidden reality of foods to us. In form this is a quasireligious idea, suggesting the visible world is not the one that really matters, which implies the need for a priesthood.” The references to religion are a bit odd, given that Pollan will later take nutrition science to task for changing its mind. More importantly, though, the need for expert help doesn’t arise so much from the focus on nutrients as the decision to care about the health consequences of our dietary choices. If I wanted to know whether white rice or brown rice would make for a healthier meal, I suppose I could get all my friends together, assign half of them to eat white rice and half to eat brown rice and then record their health outcomes over the course of the next few years. No experts required! Of course, that would take a long time, I’d probably have a pretty small sample size, and people would stop being friends with me. So I’d prefer to direct the question to the “priesthood,” even though I’d be thinking about foods, which (unlike nutrients) I can see.

Another assumption of nutritionism, he explains, is “that the whole point of eating is to maintain and promote bodily health.” Perhaps this follows if we interpret his definition of nutritionism in the most literal sense, but I would bet that only a tiny minority of people who think about nutrition in terms of nutrients actually believe that we can understand everything there is to know about a food by studying its constituent nutrients. Some might believe that we can understand the relationship between diet and disease in terms of the nutrients, but that doesn’t mean they can’t also see a place for less healthful foods in the diet now and then, perhaps for reasons of culture or pleasure.

Pollan further argues, “It follows from the premise that food is foremost about physical health that the nutrients in food should be divided into the healthy ones and the unhealthy ones–good nutrients and bad.” This is another consequence that doesn’t really follow. Though Pollan has criticized the campaign to reduce fat intake, you’d be hard-pressed to find a nutrition researcher or dietitian who didn’t understand that some amount of dietary fat is essential. The Manichaean view, then, is more a product of a lack of attention to nuance than to the ideology of nutritionism itself.

And Pollan, of course, will sound every bit as Manichaean as any supporter of nutritionism when he contrasts fresh and processed foods. Indeed, in the same chapter, he argues that “the most troubling feature of nutritionism” is that it does not allow for “any qualitative distinction between whole foods and processed foods.” Quoting Gyorgy Scrinis, he argues that in the nutritionist view, “even processed foods may be considered to be ‘healthier’ for you than whole foods if they contain the appropriate quantities of some nutrients.”

To find this idea troubling, one has to take a position that is perhaps more radical than it might sound. One has to reject, for instance, the idea that iodized salt has played an important role in reducing brain damage in infants (or, I suppose, one could reject the idea that brain damage is unhealthy). Elsewhere, David Julian McClements, César Vega, Anne E. McBride, and Eric Andrew Decker have argued that fortification of flour has played a critical role in reducing deaths due to pellagra. To be sure, there are ways to process food that are less benign, but if Scrinis and Pollan want us to believe that processed foods cannot be healthier than whole foods under any circumstances, then they need to be able to answer to these examples.

By the end of the chapter, nutritionism has become something so big and bad that it seems to encompass just about everything that’s wrong with our way of eating. Now the time is ripe for Pollan to save us from this ideology which threatens not just our health but pleasure, common sense, and even food itself.

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