ONE   ESCAPE FROM THE WESTERN DIET

The undertow of nutritionism is powerful, and more than once over the past few pages I’ve felt myself being dragged back under. You’ve no doubt noticed that much of the nutrition science I’ve presented here qualifies as reductionist science, focusing as it does on individual nutrients (such as certain fats or carbohydrates or antioxidants) rather than on whole foods or dietary patterns. Guilty. But using this sort of science to try to figure out what’s wrong with the Western diet is probably unavoidable. However imperfect, it’s the sharpest experimental and explanatory tool we have. It also satisfies our hunger for a simple, one-nutrient explanation. Yet it’s one thing to entertain such explanations and quite another to mistake them for the whole truth or to let any one of them dictate the way you eat.

You’ve probably also noticed that many of the scientific theories put forward to account for exactly what in the Western diet is responsible for Western diseases conflict with one another. The lipid hypothesis cannot be reconciled with the carbohydrate hypothesis, and the theory that a deficiency of omega-3 fatty acids (call it the neolipid hypothesis) is chiefly to blame for chronic illness is at odds with the theory that refined carbohydrates are the key. And while everyone can agree that the flood of refined carbohydrates has pushed important micronutrients out of the modern diet, the scientists who blame our health problems on deficiencies of these micronutrients are not the same scientists who see a sugar-soaked diet leading to metabolic syndrome and from there to diabetes, heart disease, and cancer. It is only natural for scientists no less than the rest of us to gravitate toward a single, all-encompassing explanation. That is probably why you now find some of the most fervent critics of the lipid hypothesis embracing the carbohydrate hypothesis with the same absolutist zeal that they once condemned in the Fat Boys. In the course of my own research into these theories, I have been specifically warned by scientists allied with the carbohydrate camp not to “fall under the spell of the omega-3 cult.” Cult? There is a lot more religion in science than you might expect.

So here we find ourselves once again, lost at sea amid the crosscurrents of conflicting science.

Or do we?

Because it turns out we don’t need to declare our allegiance to any one of these schools of thought in order to figure out how best to eat. In the end, they are only theories, scientific explanations for an empirical phenomenon that is not itself in doubt: People eating a Western diet are prone to a complex of chronic diseases that seldom strike people eating more traditional diets. Scientists can argue all they want about the biological mechanisms behind this phenomenon, but whichever it is, the solution to the problem would appear to remain very much the same: Stop eating a Western diet.

In truth the chief value of any and all theories of nutrition, apart from satisfying our curiosity about how things work, is not to the eater so much as it is to the food industry and the medical community. The food industry needs theories so it can better redesign specific processed foods; a new theory means a new line of products, allowing the industry to go on tweaking the Western diet instead of making any more radical change to its business model. For the industry it’s obviously preferable to have a scientific rationale for further processing foods—whether by lowering the fat or carbs or by boosting omega-3s or fortifying them with antioxidants and probiotics—than to entertain seriously the proposition that processed foods of any kind are a big part of the problem.

For the medical community too scientific theories about diet nourish business as usual. New theories beget new drugs to treat diabetes, high blood pressure, and cholesterol; new treatments and procedures to ameliorate chronic diseases; and new diets organized around each new theory’s elevation of one class of nutrient and demotion of another. Much lip service is paid to the importance of prevention, but the health care industry, being an industry, stands to profit more handsomely from new drugs and procedures to treat chronic diseases than it does from a wholesale change in the way people eat. Cynical? Perhaps. You could argue that the medical community’s willingness to treat the broad contours of the Western diet as a given is a reflection of its realism rather than its greed. “People don’t want to go there,” as Walter Willett responded to the critic who asked him why the Nurses’ Health Study didn’t study the benefits of more alternative diets. Still, medicalizing the whole problem of the Western diet instead of working to overturn it (whether at the level of the patient or politics) is exactly what you’d expect from a health care community that is sympathetic to nutritionism as a matter of temperament, philosophy, and economics. You would not expect such a medical community to be sensitive to the cultural or ecological dimensions of the food problem—and it isn’t. We’ll know this has changed when doctors kick the fast-food franchises out of the hospitals.

So what would a more ecological or cultural approach to the food problem counsel us? How might we plot our escape from nutritionism and, in turn, from the most harmful effects of the Western diet? To Denis Burkitt, the English doctor stationed in Africa during World War II who gave the Western diseases their name, the answer seemed straightforward, if daunting. “The only way we’re going to reduce disease,” he said, “is to go backwards to the diet and lifestyle of our ancestors.” This sounds uncomfortably like the approach of the diabetic Aborigines who went back to the bush to heal themselves. But I don’t think this is what Burkitt had in mind; even if it was, it is not a very attractive or practical strategy for most of us. No, the challenge we face today is figuring out how to escape the worst elements of the Western diet and lifestyle without going back to the bush.

In theory, nothing could be simpler: To escape the Western diet and the ideology of nutritionism, we have only to stop eating and thinking that way. But this is harder to do in practice, given the treacherous food environment we now inhabit and the loss of cultural tools to guide us through it. Take the question of whole versus processed foods, presumably one of the simpler distinctions between modern industrial foods and older kinds. Gyorgy Scrinis, who coined the term “nutritionism,” suggests that the most important fact about any food is not its nutrient content but its degree of processing. He writes that “whole foods and industrial foods are the only two food groups I’d consider including in any useful food ‘pyramid.’” In other words, instead of worrying about nutrients, we should simply avoid any food that has been processed to such an extent that it is more the product of industry than of nature.

This sounds like a sensible rule of thumb until you realize that industrial processes have by now invaded many whole foods too. Is a steak from a feedlot steer that consumed a diet of corn, various industrial waste products, antibiotics, and hormones still a “whole food”? I’m not so sure. The steer has itself been raised on a Western diet, and that diet has rendered its meat substantially different—in the type and amount of fat in it as well as its vitamin content—from the beef our ancestors ate. The steer’s industrial upbringing has also rendered its meat so cheap that we’re likely to eat more of it more often than our ancestors ever would have. This suggests yet another sense in which this beef has become an industrial food: It is designed to be eaten industrially too—as fast food.

So plotting our way out of the Western diet is not going to be simple. Yet I am convinced that it can be done, and in the course of my research, I have collected and developed some straightforward (and distinctly unscientific) rules of thumb, or personal eating policies, that might at least point us in the right direction. They don’t say much about specific foods—about what sort of oil to cook with or whether you should eat meat. They don’t have much to say about nutrients or calories, either, though eating according to these rules will perforce change the balance of nutrients and amount of calories in your diet. I’m not interested in dictating anyone’s menu, but rather in developing what I think of as eating algorithms—mental programs that, if you run them when you’re shopping for food or deciding on a meal, will produce a great many different dinners, all of them “healthy” in the broadest sense of that word.

And our sense of that word stands in need of some broadening. When most of us think about food and health, we think in fairly narrow nutritionist terms—about our personal physical health and how the ingestion of this particular nutrient or rejection of that affects it. But I no longer think it’s possible to separate our bodily health from the health of the environment from which we eat or the environment in which we eat or, for that matter, from the health of our general outlook about food (and health). If my explorations of the food chain have taught me anything, it’s that it is a food chain, and all the links in it are in fact linked: the health of the soil to the health of the plants and animals we eat to the health of the food culture in which we eat them to the health of the eater, in body as well as mind. So you will find rules here concerning not only what to eat but also how to eat it as well as how that food is produced. Food consists not just in piles of chemicals; it also comprises a set of social and ecological relationships, reaching back to the land and outward to other people. Some of these rules may strike you as having nothing whatever to do with health; in fact they do.

Many of the policies will also strike you as involving more work—and in fact they do. If there is one important sense in which we do need to heed Burkitt’s call to “go backwards” or follow the Aborigines back into the bush, it is this one: In order to eat well we need to invest more time, effort, and resources in providing for our sustenance, to dust off a word, than most of us do today. A hallmark of the Western diet is food that is fast, cheap, and easy. Americans spend less than 10 percent of their income on food; they also spend less than a half hour a day preparing meals and little more than an hour enjoying them.* For most people for most of history, gathering and preparing food has been an occupation at the very heart of daily life. Traditionally people have allocated a far greater proportion of their income to food—as they still do in several of the countries where people eat better than we do and as a consequence are healthier than we are.† Here, then, is one way in which we would do well to go a little native: backward, or perhaps it is forward, to a time and place where the gathering and preparing and enjoying of food were closer to the center of a well-lived life.

This book started out with seven words and three rules—“Eat food. Not too much. Mostly plants”—that I now need to unpack, providing some elaboration and refinement in the form of more specific guidelines, injunctions, subclauses, and the like. Each of these three main rules can serve as category headings for a set of personal policies to guide us in our eating choices without too much trouble or thought. The idea behind having a simple policy like “avoid foods that make health claims” is to make the process simpler and more pleasurable than trying to eat by the numbers and nutrients, as nutritionism encourages us to do.

So under “Eat Food,” I propose some practical ways to separate, and defend, real food from the cascade of foodlike products that now surround and confound us, especially in the supermarket. Many of the tips under this rubric concern shopping and take the form of filters that should help keep out the sort of products you want to avoid. Under “Mostly Plants,” I’ll dwell more specifically, and affirmatively, on the best types of foods (not nutrients) to eat. Lest you worry, there is, as the adverb suggests, more to this list than fruits and vegetables. Last, under “Not Too Much,” the focus shifts from the foods themselves to the question of how to eat them—the manners, mores, and habits that go into creating a healthy, and pleasing, culture of eating.