K. Dun Gifford, president and founder of the Oldways Preservation & Exchange Trust, the group that brought us the Mediterranean Diet concept a decade ago, is playing Paul Revere again.
In 1993, his objective was to gain broad support for a program to fight heart disease by increasing Americans’ consumption of healthful foods associated with countries that border the Mediterranean Sea. This year, the alarm Gifford is sounding, along with assorted nutrition scientists, concerns the surge in overweight and obesity across the United States and the failure of our government to revise its nutrition guidelines in response. As National Nutrition Month gets underway, it is worth sorting out the concerns over how Americans are eating and the role played by the government’s Food Guide Pyramid, a simple graphic that outlines the ideal diet.
Oldways contends that the average American has gained “at least 1 ounce of body weight each month, every month, for the last 10 years.” This adds up to 7.5 pounds per person in a decade. According to the National Center for Health Statistics, there are three times as many overweight teens today than there were in 1963.
Obesity (defined by the national Centers for Disease Control and Prevention as 30 pounds overweight for a 5-foot-4 person) is more prevalent. By 2000, only one state, Colorado, could claim that less than 15 percent of its residents were obese. As recently as 1995, 21 states could. A study published by the CDC projects an obesity level of 30 percent by 2010.
Obesity is the handmaiden to disease, notably hypertension, heart disease and diabetes. According to recent figures from the CDC, there are more than 200,000 diabetes-related deaths per year. Deaths from heart disease totaled 725,000 in 1998 and those from hyertension, 143,000. Nonetheless, too many Americans refuse to follow dietary advice except that contained in fad regimens.
We prefer meat to vegetables and sugar to fruit. We prefer snacking to exercise, comforted by the “no-fat” or “low-fat” wording on the snack-food package. When it comes to carbohydrates, we consume vast quantities of processed bread, pasta and grains while bypassing the same products made with whole grains. We did cut back on fat during the last decade, but revisionist nutritionists contend the loss of flavor led us to eat more, so we took in more calories than we could burn. We became fatter and less healthy.
To recognize its achievements and link them to these current worries, Oldways and the Harvard School of Public Health organized a 10th anniversary International Conference on the Mediterranean Diet in January.
The event, which drew more than 400, was more than a celebration, Gifford said in opening the conference. “We want to build on what has been done.”
What Oldways and its collaborators did over the past decade was conduct, collect and publicize research that helped establish the healthfulness of eating in the Mediterranean fashion. These and other efforts were revealing enough that, Gifford said, “no one today doubts the tight connections between diet and heart health.”
The foods of a Mediterranean diet–vegetables, tomatoes, beans, whole grains, cheese and yogurt among them–are inexpensive, widely available and pleasing. Most people of that region are not obese or diabetic. They have low rates of heart disease. No wonder the conference organizers believe it represents the best route to long-term good health and well-being.
Wandering the pyramids
Still, after 16 intense sessions over three days, it was easy to conclude that nutrition activists have reached a crossroads.
One path represents research. With the recognition that diet and health are so tightly intertwined, scientists can undertake projects that will establish more definitively the effects of specific foods. For instance, more evidence is coming that should fine-tune the reasons for following a Mediterranean-style diet instead of eating large quantities of processed foods.
The other path, which represents public awareness of and compliance with this advice, is littered with potholes of human foibles including self-indulgence and resistance to change.
At this crossroads is a cluster of pyramids, decorated like billboards with messages that represent their developers’ vision of how to reach dietary nirvana. In addition to the U.S. Department of Agriculture’s Food Guide Pyramid, a representation of its Dietary Guidelines for Americans, you will find Harvard’s Healthy Eating Pyramid; Asian and Latin diets as well as the Mediterranean effort from Oldways, and one from the Mayo clinic.
Comparisons are enlightening (see pyramids on this page). For instance, the Oldways and Harvard edifices are built on a base of daily activity and exercise, something that does not appear in the USDA pyramid. (Walter Willett, chairman of the nutrition department at Harvard School of Public Health and one of the most outspoken advocates of dietary reform, calls “excessive TV” the “No. 1 problem” for children who are overweight.)
The food base of the three most significant pyramids is grain: whole grains for Oldways, whole grains plus plant oils for Harvard (at most meals) and unspecified types of bread, pasta, cereal and rice for the government.
In ascending order (but in decreasing amounts) come vegetables and fruits (Oldways also lists beans, legumes and nuts on this level).
Harvard next climbs to a fish, poultry and eggs level, then on to dairy. Finally red meat, butter, white bread, potatoes, pasta and sweets are to be eaten “sparingly.” Vitamin pills and alcohol are placed beside but not within this pyramid.
Oldways advocates less oil and more cheese, yogurt and fish in keeping with its Mediterranean inspiration. It allows wine, beer and spirits “in moderation.”
USDA restricts nuts and legumes, is more generous with meat and fish and (here’s the rub) recommends the use of fats and oils only “sparingly.” It doesn’t even mention wine or alcohol.
On the fat issue, the government and Harvard are at polar extremes. The university’s nutritionists encourage the use of plant oils at most meals and suggest that saturated-fat carriers such as red meat and butter be used only sparingly.
Key changes
Back in Boston, Nancy Harmon Jenkins, author of “The Mediterranean Diet Cookbook,” said, “The biggest difference between this meeting and earlier ones is the emphasis on protein and fat at the expense of complex carbohydrates.”
The key dietary changes Oldways is advocating, in cooperation–if not lockstep–with the School of Public Health, are two: First, to rehabilitate “good” fats (unsaturated) as found in olive and other plant oils, while discouraging consumption of saturated fats and trans fatty acids. Second, to discourage consumption of carbohydrates (white starch) in such forms as sugar, white bread and even potatoes.
Harvard’s Willett projected that an increase in unsaturated fat consumption and a sharp reduction of carbohydrates will lead to lower levels of cholesterol and less risk of diabetes and cardiovascular disease.
Alter the source of calories, he and other nutritionists suggest, but do not consider that an invitation to consume more of them. Weight gain, and its attendant diseases, occurs when a person eats more calories than he or she burns, regardless of their source.
“Over the past 10 years, low-fat diets have been a failure,” Willett said. “Low fat has created an obesity epidemic. Here, compared to ’93, there is much more accord. We [the conference participants] agree carbohydrate quality is very important, agree that we need fatty omega-3s. We also need more data on calcium and dairy products.”
Those prosecuting carbohydrates believe the anti-fat mania of the early ’90s robbed Americans of important elements in unsaturated fats and oils while leading our flavor-starved populace to over-indulge in sugar and processed flour in the form of processed “low-fat” (but high-calorie) snacks.
The nutrition establishment is swinging toward the same view, if slowly. USDA upped its recommendation from “low” to “low to moderate fat” intake in 2000. The American Heart Association now recommends that up to 35 percent of daily calories come from fat, most of it unsaturated.
Time is of the essence
A revision of the USDA diet pyramid is due in 2005, but Willett and his colleagues don’t want to wait, arguing it does not reflect today’s research.
“We need real resources of and from government” to spread this newer information now, he said.
Government officials in Washington respond by quoting their mandate from Congress to review and revise the guidelines every five years.
“We have addressed the issue already,” says John S. Webster, director of Public Information and Governmental Affairs at the USDA’s Center for Nutrition Policy. “The guidelines clearly state that saturated fat should be no more than 10 percent of calories [per day] and fat in general be up to 30 percent. A committee will re-examine the guidelines and the Food Guide Pyramid in 2005.”
There appears to be considerable grassroots interest in the issue, judging from the Oldways conference participants.
“The room is full of dietitians and nutrition health professionals, about 150 of them,” Jenkins said. “That’s an exciting change. Ten years ago, dietitians were skeptical and fearful.”
“Charter” sponsors were the International Tree Nut Council and Welch’s, the grape juice people. In addition, trade associations present represented almonds, avocados, walnuts and peanuts, as well as olives, wine, grains, potatoes and tomatoes. Notably absent were representatives of the International Olive Oil Council, a major supporter of Oldways programs in previous years. (The reasons had to do with international politics, not science, an Oldways official said.) Representatives of the giant food producers were missing as well.
What we should eat
Even with the differences among pyramid builders, there was considerable consensus on what foods consumers should eat. Vegetables, and lots of them, was a frequent answer. Whole grains (including whole-wheat pasta) were highly recommended, too, though one conference panel became bogged down in a long discussion about how to prepare them. Frank Hu, a Harvard nutrition researcher, proposed that it is “more important” to reduce refined carbohydrates than to avoid the protein delivered by modest amounts of poultry, fish and low-fat dairy.
Still, the route to long-term health through diet still is foggy in patches, and no wonder.
“Nutrition is very individual,” said Mary Abbott Hess, former president of the American Dietetic Association. “Different diets work for different people.”
Unfazed, gadfly Gifford chose to introduce a new element into the diet quandary by suggesting that “what” we eat (the ingredients) may not be as essential to long-term dietary reform as “how” we prepare and eat our food.
He advocated discarding finite dietary rules and regulations and enlisting behavioral scientists to “craft the marketing messages and campaigns that will persuade people to modify their eating and drinking habits.”
The first salvo of this campaign, delivered on the second day of the conference, was a sleek, 26-page “eating guide” called EatWise.
The publication submits that healthful eating and weight management can be achieved without sacrificing variety and pleasure at meals.
A ray of light shines for the future, said Stephen Goldberg, a director of prepared foods at Whole Foods Markets who was a panelist at the Boston conference.
Despite testimony that consumers value cost and convenience over taste and nutrition, he said, “There are signs that fast food has reached a saturation level in this country. Consumers are embracing healthy alternatives such as salads and whole grain breads. In every city in the nation, they are looking for authentic cheap eats in ethnic restaurants. More markets and restaurants are being pressured to offer artisanal slow foods. Exercise is on the upswing.
“The message about healthy eating and healthy livinig is getting through.”
Eating well can start early
Need some realistic advice? Try these simple steps to an improved family diet
Walter Willett, chairman of the nutrition department of the Harvard School of Public Health and the author of “Eat, Drink and Be Healthy, the Harvard Medical School Guide to Healthy Eating,” has some surprisingly old-fashioned advice:
“First, limit television watching,” he says. “Excessive TV is the No. 1 problem with overweight kids.” Why? Because people sit still while watching, and they tend to eat at the same time, a bad combination. Also, TV is intellectually passive.
“When you’re actually thinking, your brain is burning more calories,” Willett says, “so the rate of calorie consumption is at its lowest level while watching television.”
“Don’t keep sodas in the home, either, or sugar-flavored beverages,” he advises. “And limit fruit juice carefully–two or three glasses a day is a lot of sugar. Try adding sparkling water to juice. Let kids squeeze their oranges.
“You may not get to the very best diet, but you can make huge improvements pretty easily,” he says.
Cut down on red meat, try to put nuts in your diet, emphasize poultry and fish more and vegetables and salads–and not necessarily steamed vegetables and fat-free salads. Fix them in ways kids like, with dressings of healthful oil and vinegar. If vinegar is too acidic for young palates, try making a vinaigrette with fruit juice.
In the carbohydrate area, choose whole-grain baked goods rather than refined ones: Whole-grain bread, brown rice, whole-grain pasta. Many breads boast of being multi-grain, but only those labeled whole grain or whole wheat really have whole grains as their main ingredient.
Most important is parental example, Willett says. “Kids do tend to follow parents in terms of exercise and eating habits. Put healthful food on the table, and if kids are hungry, they will eat it.”
— The Washington Post
