As bad as it is, the pyramid is among the most positive things the federal government has done in public nutrition education in the last generation or so. Among the tragedies is the Nutrition Labeling and Education Act of 1990, which, along with mandating nutritional labeling on most packaged food (generally a good thing, though even that is arguable), authorizes the use of (in the FDA’s wording) “claims about the relationship between a nutrient or food and a disease or health-related condition,” such as calcium and osteoporosis, and fat and cancer.

While the FDA claims that this allows consumers to make informed, intelligent choices, the reality is quite the opposite, a large-scale scam that allows packagers of processed foods to toss, say, a little calcium or soy in with their largely nonnutritive foods and claim that these foods “have the potential to prevent osteoporosis” or “reduce the risk of heart disease.”

This also allows manufacturers to use terms like “enriched wheat flour,” usually meaning flour from which nearly every nutrient has been stripped and to which is added a variety of chemically produced vitamins or minerals, leaving micronutrients in the dust. They can label foods “zero trans fat” even when they’re loaded with other fats. Or slap the ubiquitous “all-natural” label on things, though it means almost nothing. The smart consumer pays no attention to any of this. In fact, the smart consumer buys few foods that have more than one single ingredient, and almost no foods that make these kinds of ridiculous dietary claims. (As Michael Pollan says, “A health claim on a food product is a good indication that it’s not really food.”)

That profit is the motive behind pushing the wrong diet to Americans isn’t surprising. That government hasn’t protected our best interests, and that the Big Food complex of agribusiness and food manufacturers doesn’t have our best interests at heart—perhaps, sadly, this is about what most Americans have come to expect.

In addition to this confusion, the American consumer is faced with a barrage of conflicting studies about the link between diet and health, studies that Big Food often uses as a marketing tool. And it should come as no shock that Big Food, along with the pharmaceutical industry and its scientists for hire, has promoted confusion in the media and in the mind of the American consumer to contribute to our culture of overconsumption.

Is nutrition science?

It’s not entirely malicious. Human nutrition is as complicated as quantum physics, and experiments involving human subjects have some unique challenges compared with those involving electrons: you cannot, after all, ethically deprive people of nutrients or deliberately fill them with empty calories. Unfortunately, this means that we are all guinea pigs in a debate among studies ranging from the well-intentioned to those that blatantly promote one food or food component over another.

It’s the nature of science for theories to be disproved. Anyone who even casually follows physics knows that the knowledge of the last decade or the last year is frequently challenged and often even replaced by more recent discoveries.

But though physicists have their jealousies and competitions, and money is often at stake, it’s usually small potatoes—not a lot of people read about or make money on muons—compared with what’s at stake in “discovering” a “new” nutrient that can be marketed to the American public as The Next Big Thing.

Indeed, nutritionism—a term coined by an Australian sociologist, Gyorgy Scrinis; and popularized by Michael Pollan—is big money and big news. Barely a day goes by without the media calling our attention to a study claiming to have discovered a nutrient that fights cancer, heart disease, Alzheimer’s, or another fearsome disease.

Often, within a year that nutrient fades from public view or is discredited. Meanwhile, Big Food has moved into action and “enriched” packaged food—with “whole grains” (most often misleading), or flaxseed, or omega-3, or the latest exotic import. (As of this writing, that would be the acai berry, with more antioxidants—I just read—than any other natural source. Don’t rush out to buy it.)

There’s nothing wrong with proposing theories and finding results only to have them disproved. The scientific method, as we learned in high school, consists of asking a question, forming a hypothesis—a possible answer to the question—testing the hypothesis, and drawing a conclusion. Sometimes the conclusion is found to be “correct,” though even that does not mean it’s proven conclusively.

In the 1960s, sufficient evidence was gathered to support the hypothesis that smoking is a cause of lung cancer. There have been no studies (except for a few funded by the tobacco industry) that have ever given any evidence to the contrary. But obviously, not everyone who smokes develops lung cancer (nor is everyone who develops lung cancer a smoker). So there is a correlation, not a perfect cause-and-effect relationship.

Perhaps in part as a result of the enthusiasm those studies generated it was declared that saturated fat caused heart disease. Now there may in fact be a correlation here, but it’s nowhere near as strong as that between tobacco and lung cancer. However, the link was being described as cause and effect, a far stronger one.

But this has never been proved; rather, all you can say with assurance is that something in the American diet causes obesity and increases the rate of heart disease. It’s an epidemic, ultimately affecting more than half the population, and it’s not found in anything approaching this frequency in countries where people follow more traditional diets like those of Italy, Japan, China, Mexico, India—you name it—no matter where you look.

In any case, saturated fat is just part of the American diet, not the entire American diet. And though saturated fat may be a part of the problem, the problem is certainly not entirely the result of too much saturated fat.

In retrospect, it appears that the wise advice, 30 years ago, would simply have been, “Eat fewer animal products and nutrition-poor—i.e., junk—food; eat more plants.” This is a simpler message, and far easier to understand, than, “Reduce saturated fats and keep total fat consumption to less than 30 percent of your total calories,” which not only required far more understanding of nutrition than most people had, but also required a calculator. And it led people to believe that as long as food was low in saturated or total fat, they could eat as much of it as they wanted to, thus measurably eating more calories, and measurably increasing the rates of obesity, diabetes, and heart disease—at a minimum.

By encouraging the consumption of more meat (most people who cut back on saturated fat did so by substituting chicken for beef, and for a variety of reasons—quite possibly because they believe it to be “healthier”—they ate more), of refined carbohydrates, and of trans fats and chemically extracted oils (all low in saturated fats), the government-endorsed dietary model may have led to more deaths than it claims to have prevented. If, during the last 40 years, the government had been promoting a diet of less meat and refined carbohydrates and more vegetables, fruits, legumes, and whole grains, we’d unquestionably be a healthier country.

In fact the risk factors for heart disease and the incidence of many cancers continue to rise, and cardiovascular disease remains the number one cause of death. In recent years Americans’ life expectancy became the second-worst in the industrialized world, just ahead of Latvia.

Since as a country we do eat less saturated fat than we used to, we can probably say that this kind of fat is not the sole culprit. A more likely candidate is the typical American diet.

Yet if it’s so simple—“Don’t eat the modern American diet, and your health will improve” (in fact it is almost that simple)—then why do so many recent nutritional studies do little more than confuse us?

Let’s study which diets work

Most studies about diet are contradictory, and definitive results are rare. To illustrate this, let’s take a look at the well-publicized Nurses’ Health Study and some work done on the Atkins diet, both in the mainstream, both well-intentioned, and both—as far as I can tell—examples of research that in the long run may forward the cause of knowledge but in the short run don’t give us much guidance.

The Women’s Health Initiative (WHI) Dietary Modification Trial is part of the Harvard Nurses’ Health Study, begun in 1978 and among the longest-lasting of health studies. Starting in 1993, the WHI trial followed nearly 50,000 women in an attempt to demonstrate the health benefits of a low-fat diet.

It did no such thing. Rather, it found that women on low-fat diets did not have lower rates of breast cancer, colorectal cancer (thought to have been at least partly caused by excessive fat intake), or cardiovascular disease.

The study did not even demonstrate that low-fat diets aided in weight loss: women on the WHI diet generally weighed the same as women who followed their usual diets. (Many people believe that women on the diet “cheated,” and of course cheating is not uncommon in such situations. But this is not a criticism of anyone: You cannot monitor food intake constantly, or force people to act against their will. Again, this is among the core problems with studies in nutrition.)

All this came as a rude awakening to the health and diet industry, which had expected this large study to confirm its well-publicized beliefs, beliefs previously substantiated by other studies, including the Women’s Intervention Nutrition Study (WINS), which made news when the researchers reported that a low-fat diet may help prevent breast cancer. In this study, 2,437 women who been treated for breast cancer maintained either a low-fat diet (their consumption of fat was 20 percent of their daily calories) or a standard diet. The low-fat group showed a 24 percent reduction in the risk of a recurrence of the cancer.

So, which result is “true”? Both are, or neither is. More studies are needed. In the long run—which may mean 20, 50, or 200 years—whether diet can reduce the risk of cancer will become clear. But it isn’t clear now.

Let’s look at a study of a diet that may be thought of as the anti-carbohydrate and essentially pro-fat diet—most often called the Atkins diet, after the doctor who popularized it. In 2002, in a study at Duke University, some participants were fed 60 percent of their calories as fat while their carbohydrate intake was kept low; the other participants followed the American Heart Association diet—low in fat and relatively high in carbs. Those on the Atkins diet lost more weight and—stunningly—had better cholesterol overall.

But five years later, a study at the University of Maryland Medical Center found that “people on the Atkins diet had increased levels of LDL (‘bad’) cholesterol,” and these researchers declared that the maintenance phase of the Atkins diet not only led to no weight loss but was “potentially detrimental” for cardiovascular health.

Confused? You should be. And it’s worse than it appears. There are those who argue that the WHI diet was not even a real low-fat diet, and that therefore its results don’t tell us much. And others argue that the markers used to measure the success or failure of both diets are irrelevant, and therefore that neither diet tells us much about anything.

In fact, it may be that extreme diets—at least those used for weight loss—are themselves unhealthy. A recent study at UCLA, the most comprehensive and rigorous analysis of diet studies to date, found that people on diets typically lose 5 to 10 percent of their weight in the first six months, but that within four or five years between one-third and two-thirds of them regain more weight than they lost. Also, there’s evidence to suggest that repeatedly losing and gaining weight is itself linked to cardiovascular disease, stroke, diabetes, and altered immune function.

Not only do many studies contradict one another; the hopeless consumer is led by the nose, following the diet of the year or looking for the nutrient of the month. After 20 years of being told that polyunsaturated fat was the key to good health, we were then told that the hydrogenated forms, known as trans fat because of the trans fatty acids that form their chemical structure, are in fact damaging. This means that more than 30 years after first hearing that butter was “bad,” we learned that the common substitutes like margarines and vegetable shortening were likely to be worse.

After a series of studies “determined” that oat bran lowered cholesterol (remember, it’s not even clear that cholesterol is “bad”), oat bran was marketed as if it were the greatest thing since the Salk vaccine. But a more careful study found that high-fiber diets didn’t directly reduce cholesterol. Rather, it seemed, that by eating oat bran people simply ate less of foods that could be damaging. Similarly, olive oil itself probably has no benefit other than that people use it in place of more harmful fats.

Olive oil and oat bran, for example, may indeed have beneficial effects, but perhaps these show up in studies because by eating them people are not eating something that might be damaging, and this is important.

It could well be—and this is as close as I can get to Something I’m Very Nearly Sure Of—that by eating simple, natural, minimally processed foods, known to be at least benign if not beneficial, in place of foods that are suspect in any quantity (junk food, highly processed carbohydrates), or those that may be damaging if consumed in large quantities (animal products), you’re going to be healthier and quite likely thinner. And if you believe me, you don’t need to follow the results of any more studies.

So why fund studies?

What good, then, are nutritional studies? Undoubtedly they move knowledge forward, however slowly and falteringly. Were it not for these studies, journalists, researchers, and nutritionists would not be able to see emerging patterns. (Each person may draw different conclusions, but the best studies and the most knowledgeable commentators are currently all pointing in a similar direction.)

But since many studies are funded by the same people who raise, manufacture, and market the products being researched, they must often be viewed skeptically. The potential benefits to sponsors in discovering that their food is “healthy” are great.

The commodity boards discussed in Selling the Bounty usually require their members to contribute to research as well as promotion. So we see studies like these:

• The United Soybean Board funded research that established a link between consumption of soy protein and a reduced risk of heart disease. (In 1999, this discovery led to the Food and Drug Administration’s establishment of a health claim regarding the cardiovascular benefits of soy protein.) Now, the same board is partially funding a study by the National Institutes of Health (NIH) into the role of soy in preventing prostate cancer.
• The California Walnut Board helped pay for a study showing that walnuts may be better for heart health than olive oil.
• The Almond Board of California and Unilever (manufacturer of Take Control margarine) were behind a study to show the cholesterol-lowering benefits of foods like raw almonds, tofu, and margarine enriched with plant sterol—like Take Control.

Like many studies, these found what they were looking for. That’s not surprising: A study showed that research on soft drinks, juice, and milk had a better likelihood of favorable outcomes when funded by the food industry. And if studies don’t find exactly what their sponsors want, there are ways of dealing with that, too:

• In 2007, a look at studies funded by a single drug company found that they had a 55 percent rate of getting the results desired by their funders, but that they were reported positively 92 percent of the time. (This gap vanishes entirely when studies are performed by nonprofit institutions.)
• A study at the University of North Carolina revealed that studies of breast cancer therapies are more likely to report positive results when funded by the pharmaceutical industry than when funded by other sources. This review showed that industry-funded studies are designed for positive outcomes, often looking only at how a drug performed, without a control group for comparison. (Many studies with control groups taking placebos—substances that have no medical effects, like sugar pills—find the placebo as effective as the drug being tested.)
• Researchers at the University of California–San Francisco found that when trials compared two cholesterol-lowering drugs, the results were 20 times more likely to favor the drug from the company that funded the study.
• A story in the New England Journal of Medicine reports that 94 percent of positive studies funded by drug companies find their way into print. The number for those with ambiguous or negative results?—14 percent.

The disconnect between data and reporting is called spin. And people believe it.

Olive oil, walnuts, and acai berry—all intrinsically healthful foods—are good examples of foods that have taken advantage of their status as magic bullets to raise sales. Olive oil consumption has nearly tripled since 1991; walnut consumption reached a record high in 2004/05, of 0.54 pounds per person; and the acai berry has seen sales triple in just three years, from $3.8 million in 2005 to $13.5 million in 2007.

Why? Because we’ve been led to believe that there may be a magic bullet for our health problems. In general the health industry continues to promote consumption and “cure” over straightforward lifestyle modification. Whether it’s taking a pill to lower cholesterol or eating acai berries, the promise of an easy solution trumps eating and living simply and sensibly.

The food and pharmaceutical industries benefit mightily from this belief, so it throws literally billions of marketing dollars a year at reinforcing the behavior. (In 2007, all the potential “blockbuster” drugs—those with potential sales of $1 billion or more per year—were designed to combat lifestyle diseases: diabetes, heart disease, and obesity.)

The value of these studies would diminish substantially if we ignored them. But with the print, broadcast, cable, and Web media competing for our attention, every bit of “news” is treated as earth-shattering, even if the sources are questionable. There is no news value in saying, “Eat a sensible diet,” whereas there is enormous news value in saying, “New omega-3 research shows cancer reduction”—followed, quite likely, by a commercial for soy milk fortified with omega-3s.

There is no magic bullet

The easiest, surest way to improve the overall health of Americans is for us to adjust our eating habits. We’re not talking about a diet. It’s a change in focus, away from the twentieth-century style of eating and back to something saner, more traditional, and less manufactured.

It’s indisputable that our excessive food intake is bad for our health. The full effect of obesity on overall health has not been determined, but at the very least it’s responsible for reduced mobility and circulation, and for stress on several organs. And there’s no question that we’re getting fatter, so much so that there are people who use the term “obesity epidemic.” There are twice as many overweight adults as there were 25 years ago, and about three times as many children and teenagers.

Meanwhile, heart disease, cancer, and stroke remain the first, second, and third leading causes of death in the United States. About 70 million Americans (almost one-fourth of the population) have some form of cardiovascular disease, which is responsible for more than 6 million hospitalizations each year. Nearly 21 million Americans suffer from our sixth-biggest killer, diabetes (and six million of them don’t know it); and another 41 million have pre-diabetes. It seems absurd to put a cost on these diseases, but people do, and the latest cost estimate for diet-related illnesses—heart disease, stroke, diabetes, obesity, and cancer—is roughly $840 billion, according to the Centers for Disease Control (CDC). (The budget for Social Security, by comparison, is $657 billion.)

Almost everyone believes that these are diet-related diseases. The CDC believes that much of the burden of heart disease and stroke could be eliminated by reducing their major risk factors: high blood pressure, high cholesterol, smoking, diabetes, physical inactivity, and poor nutrition. Others estimate that improved nutrition and lifestyle could reduce illness and death from cancer by as much as 40 percent, death from cardiovascular disease by up to 30 percent, and cases of diabetes by at least 50 percent. Those are big numbers, and “improved nutrition and lifestyle” is the approach that Food Matters shares.

We have not been moving in the direction of “improved nutrition,” though, and consequently we’ve seen the situation get worse. Since 1990, those diagnosed with diabetes have increased 61 percent; since 1991, the prevalence of obesity has increased 75 percent; and heart disease is not only the number one killer of adults: frighteningly, it’s also the second leading cause of death for children under 15.

But if we know what to do, and we know how to do it, why aren’t we doing it? The answers are complicated and not entirely clear. For one thing, we’re not agreed on what to do. For another, there is a disincentive on the part of the food industry for us to change the way we eat. And for a third, the government agencies that might encourage the “right” diet are beset by confusion and by their ties to the food industry.

It would be unprofitable—for Big Food at least—if we moved our eating habits in the right direction. But not only would profits fall if we ate a moderate diet of wholesome foods; so, too, would the rates of lifestyle diseases, global warming, our collective weight, antibiotic use, environmental damage, and cruelty to livestock. What’s stopping this move, largely, is inertia, habit, a lack of good information, and a drive to maintain the status quo by the people who profit from it. But maintaining the status quo is insane.