Rethinking healthy starts with rethinking nutrients.

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This year looks to be pivotal for rethinking healthy. At the highest governmental level, the FDA has committed to release new guidelines for label claims. As the FDA commissioner put it earlier this year:

“Healthy” is one claim that we believe is ripe for change … Traditionally, we’ve focused primarily on the nutrients contained in food in considering what is healthy. But people eat foods, not nutrients. This is why we’re asking the important question of whether a modernized definition of “healthy” should go beyond nutrients to better reflect dietary patterns and food groups …

Emphatically my answer is yes.

An FDA mandate for nutrient claims only covers consumer packaged goods. And maybe even restaurant menu labels at some point in the future. But what the FDA decides makes a packaged food healthy permeates the general food ecosystem. When FDA defined healthy in the early 1990s as low fat and low sodium, low fat reigned supreme for a decade.

Nutrients are important. No argument here on that point. As a dietitian and culinary nutritionist, I spent a couple years learning just how important they are. But so is food. And taste. And culture. And tradition. Not to mention enjoyment. So I applaud the decision to acknowledge that food is as much a part of a healthy pattern as nutrients. Defining healthy as the sum of the nutrient parts is called a reductionist perspective.

The problem with a reductionist perspective.

Reducing a food to the sum of its nutrient parts tends to skewer the meaning in a negative direction. Especially when, as was the case in the 1990s, healthy was defined in terms of 4 nutrients to avoid:  sodium, cholesterol, total fat, saturated fat.

Now feast your eyes on my shrimp and greens salad pictured above. Note the variety of vegetables on the plate: a generous handful of arugula, a dark green vegetable, some radicchio, a couple of small tomatoes, and some sliced scallions. The greens make up the bed for those lovely freshly steamed wild caught North Carolina shrimp.

Remember that under the original concept of healthy, food did not count. Well, those pristine steamed shrimp are salty. All shrimp are salty. Shrimp live in the sea and the sea is salty. When healthy was measured by counting milligrams of sodium per 100 grams, shrimp are automatically knocked out.

Remember too under the original concept, palatability did not count. Salads taste better when they are served well dressing, but a couple of tablespoons of fine olive oil and sherry vinegar added too much fat and saturated fat.

In other words, the only way to make this plate healthy under the original concept was to remove the shrimp, hold the vinaigrette, and serve the greens naked.

This reductionist view of healthy did a lot of damage. Is it any wonder so many folks rejected such a austere approach and labeling a food healthy became the kiss of death?

What a difference a couple of decades makes.

A lot has changed since 1994. That’s the year the Nutrition Labeling and Education Act became law and the draconian nutrient content claim for healthy was cast in regulatory cement.

In 2016, The FDA released a preliminary working document indicating their thinking on revising the nutrient criteria for labeling food healthy.

Use of the Term “Healthy” in the Labeling of Human Food Products: Guidance for Industry.

And with the release of the most current Dietary Guidelines in 2015, a healthy pattern took precedence over unhealthy nutrients.

Previous editions of the Dietary Guidelines focused primarily on individual dietary components such as food groups and nutrients. … The 2015-2020 Dietary Guidelines provides five overarching Guidelines that encourage healthy eating patterns, recognize that individuals will need to make shifts in their food and beverage choices to achieve a healthy pattern, and acknowledge that all segments of our society have a role to play in supporting healthy choices.

So what do these changes mean for my shrimp and greens salad?

Bottom line is that my simple little salad of greens, tomato, shrimp, and vinaigrette just got a whole lot healthier.

Thanks to revised thinking from the FDA, the ratio of saturated to unsaturated fats is now more important than just the grams of saturated fatty acids. Olive oil, although it does contain a significant franction of saturated fatty acids has a stellar ratio of almost 6 to 1.

And thanks to the Dietary Guidelines, the pattern and the whole plate are now important. Food counts and you get bonus points for more fish like shrimp and more dark green vegetables like arugula.

We’re not there yet, but my sense is we may actually be moving in the right direction.

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Will 2018 be the year I can finally eat healthy?

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Healthy eating has been in a state of transformation now for the last couple of years. It’s hard to date exactly when the sea change started but we’ve gradually been moving away from low fat, restrictions, and deprivations.

During the 1990s healthy really was synonymous with low fat, restrictions, and deprivations. That was decade when restaurants stopped using the word because they quickly determined that labeling a new menu item heart healthy or low fat was the kiss of death.

Home cooks and creative chefs have probably never paid all that much attention to nutrition guidelines and, just between you and me, I never cooked low fat at home even though I did my nutrition studies during the 1990s. But mainstream Americans embraced carbohydrates and sugar and cut out the fat.

I knew things were happening in the academic community when I started seeing studies like these here and here and here.

And if I were asked to provide pivotal dates, I would cite the publication of the 2015-2020 Dietary Guidelines because of the implicit acknowledgement that the sum may be greater than its individual parts.

Previous editions of the Dietary Guidelines focused primarily on individual dietary components such as food groups and nutrients. However, people do not eat food groups and nutrients in isolation but rather in combination, and the totality of the diet forms an overall eating pattern.

Or perhaps the FDA decision to exercise enforcement discretion as the agency reviews labeling criteria for manufacturers who want to label their products healthy.

But when I see a statement like the one below from a restaurant consulting group suggesting deprivation and restriction need no longer be a necessary component of healthy eating, I begin to think 2018 may actually be the year when the pieces fall into place. Healthy Dining is a San Diego based restaurant consulting group. Here’s that quote from the CEO from a recent blog:

There’s a new trend in healthy eating and restaurant dining, and it is leaving behind restriction and deprivation in favor of savoring great meals at restaurants that support a healthy lifestyle.

So you may be wondering what all this has to do with my lovingly prepared and very tasty chicken tagine pictured above?

Well let me explain. Even by current liberalized criteria, my tagine is not technically healthy.  Despite using quality ingredients and significant amount of vegetables to compliment the chicken thighs, my cooking uses more olive olive than is currently recommended.

Since the 1990s when those draconian criteria were cast in regulatory concrete, many of my zealous colleagues have dutifully taken classic recipes like the one I used for the tagine and made adjustments to the proportions to restrict fat, saturated fat, and sodium.

Relief is in sight however. To their credit, the FDA has acknowledged the need to revise that criteria. And I say congratulations. Maybe a little late, but better late than never …

What will the new criteria look like?

Hopefully a better way to asses the food and nutrition values of a dish like the one pictured above. We need a scoring system that awards points for making half the plate vegetables plus positives like fiber and protein. Then we need that same scoring system to balance those positives against sodium and saturated fats.

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