I always giggle a little bit (to myself) when someone comes into my office and informs me that they are a healthy eater. What exactly does that mean? Does that mean they eat sugar in moderation? And what's that, exactly? Does eating healthy mean they avoid meat? Eat whole grains? Avoid saturated fats? And really, is it possible to be a truly healthy eater living in modern America? I suspect not, actually.

Let's take a look at breakfast. What's healthy? Oatmeal? A whole-grain flaky cereal? Maybe, if you're not insulin resistant or diabetic — this recent study that just came out in December 2014 showed that the concept of "good carbs" with a low glycemic index actually have the same negative effect for people with blood sugar issues as "bad carbs" like a sugar cereal or white bread toast.¹

Let's say you pour some milk over it — is that whole milk? It would be much better if it was because drinking low-fat milk increases obesity in kids and also in adults.^2,3,4 Let's say that you try to make the "right" choice and buy turkey bacon instead of regular, because you have been told, time and time again, that saturated fat is going to end up in your arteries. Never mind that that isn't accurate, but did you know that lard is actually a mono-unsaturated fat, putting it in the same category as olive oil? Don't even get me started about eggs!

Can you see the issues? One is that we have been indoctrinated with repetitions from doctors, advertisements and articles that certain concepts assumed to be correct, and other ones are wrong, and we are oddly sure that we know these things to be fact. I use the word "oddly" because this type of certainty isn't actually borne out in research.

The second issue is that since most of us don't stay up with current information, much less look at actual research, the problem lies then in the fact that we keep old ideas circulating rather than using a combination of common sense, a view of traditional diets, and current research. And the third problem is, we're assuming a few things that might be getting us in a little trouble, but I'll get to that in a moment.

I've had a few patients complain to me that it's so hard to know what the right thing to eat is, and it seems as if we're constantly doing a 180 — eggs are good, then they're bad, then they're good, or fat is prized, then it's pilloried, and now butter is on the cover of Time magazine. And I can totally understand. What I ask them to see is this — have they noticed that the 180 turn-arounds they're noticing are actually 360's, if you're looking with a wide-enough angle back into the past of traditional diets? That the foods we now demonize were prized enough in the past that, for example, when you didn't have enough money to buy fatty meat with flavor, that you would use a larding needle to sew pork belly into the inexpensive lean meat to give it flavor? Part of our problem is we don't have enough context in time to see where we are versus where we've been food-wise, so we see only the last 30 or 40 years and think that's how it's always been. But we actually have no idea.

Let's just look at sugar. Everywhere people are recommending sugar in moderation, but what exactly does that mean? Does that mean not having sugar every day? Do you personally make it through a day without sugar? How about two? The estimation now is that a child, by the time he or she is eight years old, has eaten the amount of sugar a person ate in his whole lifetime 100 years ago. You really want that to sink in. We think having sugar every day is normal, that having dessert after dinner every day is okay. My mother didn't have sugar at all in her childhood, growing up during a war, and had her first banana at the age of 11. Of course, this explains why the fastest growing group of Type 2 diabetics is adolescents, and it's especially scary because the medications for diabetes don't work on them for unknown reasons. This generation of children is known to be the first generation that will not live as long as it's parents.

Then there are our assumptions about other "healthy" foods, with one of the biggest recommendations being to eat whole grains. If there is one thing people argue with me about, it's that whole grains have a place in a healthy diet. There are a couple of big problems, though, that as modern people we conveniently overlook, and one is that grains, nuts and seeds come with phytic acid, which is called an "anti-nutrient" because it prevents to absorption of multiple minerals. This is so well-known that it is written in mainstream nutrition textbooks and it is recommended that people don't take their vitamin pills when they eat those foods.⁵

Lectins are included here as well. How did traditional people avoid this malnutrition when eating grains, nuts or seeds? They soaked, sprouted or fermented them to turn off those digestive inhibitors. But do we do that now? No, of course not, because that all takes too much time. The second issue with whole grains is that, despite having a lower glycemic index, when someone is carbohydrate intolerant, like someone who is pre-diabetic or diabetic, the presence of fiber does not prevent the damage coming from insulin from eating another carbohydrate, even one considered "healthy." This is also borne out in research, with the study I mentioned earlier, pointing out that despite our assumption that fiber will save us, high glycemic and low glycemic foods have the same reaction on insulin sensitivity, systolic blood pressure, LDL cholesterol, or HDL cholesterol — that is, not a good one. The Scottish could eat oatmeal their whole life because they also didn't eat sugar, for the same reason the Japanese could eat white rice their whole lives and not get diabetes. If you eat sugar they way we have and you "break" your system, then even whole grains will be problematic.

What about making sure we eat enough fruits and vegetables? You're assuming, of course, that there are actual nutrients in produce, which has been shown recently to be declining due to soil quality.^6,7 It would be better to eat organic, but that's not easy to do for many people for reasons varying from cost to availability. Not to mention that the minimum recommendation is 5 servings a day, which most people do not get. It's estimated that less than 10% of people under the age of 50 get the minimum servings of 5 per day, and that's not taking into account a decrease in their nutritional value.

The low-fat craze is finally reaching it's end, although it'll be years before people realize that low-fat milk is just sugar-water, lactose being the sugar. There are few, if any, examples of where we have caused so much harm to a population in so short a time. The diabetes epidemic is, in large part, caused by the outdated Food Pyramid and the low fat recommendations. By unbalancing our food intake with the reduction of fat, we increased our carbohydrates, ate much more protein, and reduced our intake of fat-soluble vitamins, all because we labeled a macronutrient like fat "bad." I have no idea how long it will take us to undo the thinking that bacon fat is lining our "pipes" but there's no doubt that was some of the most effective marketing ever. Unfortunately, while the research was wrong, our adherence to incorrect ideas is impressive, even in the face of evidence. It'll be decades before we go back to eating chicken skin!

Then, of course, there's salt. If there's one thing we know, it's that salt causes hypertension, right? Well, not exactly... this study from 2014, titled, "The Wrong White Crystals" points out that sugar, far more than salt, is responsible for high blood pressure.⁸ And the low salt recommendations that the American Heart Association keeps pushing, at 1500 mg/day has been shown to increase mortality⁹ and increase insulin resistance.¹⁰ The constant exhortations to not salt your food at the table? Or not use any while cooking? At best, that's responsible for 11% of someone's sodium intake, while processed foods are responsible for 77% (the natural sodium found in foods is the remaining 12%).¹¹ Perhaps, if we stopped eating processed foods, with their high sugar and salt content (and this includes the "healthy" snacks and processed foods at Whole Foods market, we might get our systems into a bit more balance.

What about abstaining from alcohol? Not a good idea if you want to reduce your mortality from strokes, coronary heart disease, or all other causes of mortality.¹² "But it causes cancer!" some people will say. Apparently this happens in nutritionally deficient people,¹³ which, at this point, is nearly everyone. Avoid red meat? Yes, if you're eating the corn-raised, feed-lot cattle, but eating red meat is probably not your biggest issue. Neither is coffee, dairy or your lack of access to a farmer's market. Trying to be vegetarian? True, no one eats enough vegetables, but many vegetarians are "carbotarians" and have a tendency to have multiple nutrient deficiencies, all the while thinking their plant-based diet will save them. Research shows it won't.¹⁴

The biggest issues facing people today is a dependence on processed foods (even supposedly healthy ones), a high carb/sugar intake, and an ironic attachment to the ideas that got us in trouble in the first place. One of the best things you can do is start eating real food, refuse to buy low-fat or processed foods, and eat in balance. And taking a whole food supplement would help, since, at this point, most of us are deep enough a nutritional hole that eating well won't be enough to get us out of it.

References:

1. Sacks, Frank M., et al. "Effects of high vs low glycemic index of dietary carbohydrate on cardiovascular disease risk factors and insulin sensitivity: the OmniCarb randomized clinical trial." JAMA 312.23 (2014): 2531-2541.
2. Scharf, Rebecca J., Ryan T. Demmer, and Mark D. DeBoer. "Longitudinal evaluation of milk type consumed and weight status in preschoolers." Archives of disease in childhood 98.5 (2013): 335-340.
3. Holmberg, Sara, and Anders Thelin. "High dairy fat intake related to less central obesity: A male cohort study with 12 years' follow-up." Scandinavian journal of primary health care 31.2 (2013): 89-94.
4. Kratz, Mario, Ton Baars, and Stephan Guyenet. "The relationship between high-fat dairy consumption and obesity, cardiovascular, and metabolic disease." European journal of nutrition 52.1 (2013): 1-24.
5. Nix, Stacy. Basic Nutrition and Diet Therapy. 13th Edition. Mosby Elsevier, St. Louis. 2009.
6. Marler, John B., and Jeanne R. Wallin. "Human Health, the Nutritional Quality of Harvested Food and Sustainable Farming Systems." Nutrition Security Institute. Bellevue (2006).
7. Lal, Rattan. "Soil degradation as a reason for inadequate human nutrition." Food Security 1.1 (2009): 45-57.
8. DiNicolantonio, James J., and Sean C. Lucan. "The wrong white crystals: not salt but sugar as aetiological in hypertension and cardiometabolic disease." Open Heart 1.1 (2014): e000167.
9. Graudal, Niels, et al. "Compared With Usual Sodium Intake, Low-and Excessive-Sodium Diets Are Associated With Increased Mortality: A Meta-Analysis." American journal of hypertension (2014): hpu028.
10. Garg, Rajesh, et al. "Low-salt diet increases insulin resistance in healthy subjects." Metabolism 60.7 (2011): 965-968.
11. Mattes, R. D., and D. Donnelly. "Relative contributions of dietary sodium sources." Journal of the American College of Nutrition 10.4 (1991): 383-393.
12. Ronksley, Paul E., et al. "Association of alcohol consumption with selected cardiovascular disease outcomes: a systematic review and meta-analysis." Bmj 342 (2011).
13. Zhang, Shumin M., et al. "Plasma folate, vitamin B6, vitamin B12, homocysteine, and risk of breast cancer." Journal of the National Cancer Institute 95.5 (2003): 373-380.
14. Burkert, Nathalie T., et al. "Nutrition and Health–The Association between Eating Behavior and Various Health Parameters: A Matched Sample Study."PloS one 9.2 (2014): e88278.