When it comes to determining if the latest popular diet or nutrition trend is merely a fad or a true paradigm change, processors have their work cut out for them. Not only must they do their homework to determine if the science matches either the claims or the public perception, but they must also investigate the practicality of the regimen and whether the investment in it will be helpful to the consumer while still being worthwhile to the manufacturer.
When queried about why they want to lose weight, a significant number of consumers cite the need to ward off heart disease. According to the American Heart Assn., advances in clinical care over the past several decades have translated into far more people surviving heart attacks.
Over the same period, the characteristics of those surviving heart attacks also have changed, with a greater prevalence of obesity, metabolic syndrome, and type 2 diabetes, similar to changes in the general population. But with obesity staying at epidemic levels and heart disease being a leading cause of death, losing weight has become an imperative for tens of millions.
As a result, the American Heart Association guidelines for heart attack patients stress achieving and maintaining a healthy weight through diet and exercise, consistent with 2015-2020 dietary guidelines for Americans that emphasize achievement and maintenance of a healthy eating pattern over a lifetime.
Beyond that goal, consumers now view dieting as not only a weight-loss regimen but also a tool to achieve the proactive goals of enhanced immunity, increased energy, and slowed aging. In short, diets must be all-encompassing and inclusive. And for developers of diet foods and beverages, that means the products must be so as well.
The question of what constitutes a healthy lifetime dietary pattern has come under increasingly intense scrutiny. Certainly, there is little argument with the advice to increase fruit and vegetable intake. But recent popularity of low-carbohydrate diets, coupled with the (sometimes overgeneralized) restoration of the reputation of fat, has given many consumers the impression that all dietary advice is questionable. This is particularly true with respect to dietary fat and cholesterol.
So, when it comes to diets, which approach yields the best results? Low fat? High fat/high protein? High or low carbohydrates? In some studies, low-carbohydrate diets have been associated with short-term weight loss, reduced levels of circulating triglycerides, and enhanced high-density lipoprotein (HDL) cholesterol, markers that should signal protection from further heart attacks. However, data on long-term effects of low-carbohydrate diets are sparse, and the effect of diets aimed at weight loss among heart attack survivors had not been well studied until recently.
A report published in 2014 in the Journal of the American Heart Association compiled data from two ongoing studies, the Nurses’ Health Study (a prospective cohort of 121,700 registered female nurses, 30 to 55 years of age at enrollment in 1976), and the Health Professional Follow-up Study (a prospective cohort of 51, 529 US male health professionals aged 40 to 75 years of age at their enrollment in 1986).
Participants in both lifelong studies answer questionnaires twice per year on lifestyle and medical history. The report considered a sub-cohort of 2,258 women and 1,840 men, all of whom were heart attack survivors, yet free of cardiovascular disease, stroke, and cancer at the time of enrollment in their respective cohort studies. Each provided at least one pre- and post-heart attack food frequency questionnaire.
The results of the study suggested a pattern consistent with other studies on low-carbohydrate diets that does not support public perception: There was no observed health benefit associated with greater adherence to a low-carbohydrate diet after the initial heart attack. In addition, the greater the adherence to a low-carbohydrate diet high in animal fat and protein, the higher the all-cause and cardiovascular mortality following the original heart attack.
An earlier study, published in 2006 in the New England Journal of Medicine and using the Nurses’ Health Study alone as its database, suggested that diets lower in carbohydrates and higher in protein and fat did not increase the risk of heart disease in women. However, when sources of fat and protein were of vegetable origin, these diets could moderately reduce the risk of coronary heart disease, the study found.
The Low-Carb Message
These and similar studies suggest a caveat to the “low-carb” message: Not all low-carb diets are created equal. More importantly, credibility cannot be transferred from one to another: Ingredients are more important than the crude macronutrient proportions.
A serious problem with evaluating any low-carb diet and presenting the information to the public is that the label. “Low-carb” has no set definition. Foods rich in carbohydrates are highly varied in composition. Black beans and jelly beans are both rich in carbohydrates, but obviously not nutritionally equivalent. By definition, carbohydrates are a diverse group of compounds—so diverse that many consumers fail to grasp the differences.
Sugar—specifically, glucose—is the basic unit of practically all carbohydrates. The term “sugar” in everyday conversation commonly denotes something that tastes sweet and dissolves in water. However, there are multiple types and forms of sugar. Starches are made of sugars, long chains of glucose molecules, and so are fibers.
Fibers can include sugars other than glucose. The main difference between starch and fiber is that the sugars that make up starch are released during digestion to be used for energy. The sugars that make up most fibers are bound together in a manner that thwarts the digestive process. The intact chains reach the colon where they benefit the digestive process, but contribute little to energy needs.
Exchanging a burger, French fries, and a sugar-sweetened beverage for fish and an abundance of green vegetables certainly represents a move from a high-carb diet to a low-carb diet, and it undoubtedly benefits one’s health. But the benefits of such a change do not constitute evidence that potatoes are a bad food or that grains are unnatural, nor does the idea behind such a shift translate to permission to eat all the meat, eggs, cheese, and bacon desired as long as all forms of carbs, including fruits are severely reduced.
The glycemic index (GI), a tool developed to help persons with diabetes, was appropriated for diets in the belief it could help to clear up carbohydrate confusion. Supposedly applying a GI number to diet foods would make sense for consumers eating for health. The index evaluates carbohydrates based on their immediate effect on blood sugar, with white bread (and its glucose content) used as a reference point. But popularizing the GI by applying it outside of its original diabetes-related context gave rise to several public perceptions that were overstated and overgeneralized.
According to the GI, foods that cause a rapid rise in blood sugar and subsequent spike in insulin (the hormone secreted by the pancreas in response to increased blood sugar) are judged as “bad.” Foods that cause a steadier rise in blood sugar after eating are seen as “good.” This concept rapidly became the modern line of demarcation between good and bad carbs. Public perception did not match up to the science.
The flaws in evaluating carbohydrates on the basis of glycemic index became immediately apparent to nutrition experts, because so many factors that are independent of carbohydrate quality affect the rise in blood sugar. Soluble fiber, fat, and fructose all tend to lower the glycemic index. Some candy bars rich in fat and fructose could have the same glycemic index as beans, which are rich in soluble fiber.
Cooking method, time of day, and other meal components all can affect GI numbers. Also, a glycemic index reveals nothing about the fate of the ingested sugar. Rapidly absorbed sugar can end up as muscle glycogen, a potent muscle fuel, which means “fast” sugar is not always bad.
Many nutrition researchers have abandoned glycemic index for glycemic load. However, because the glycemic load of a food is a product of the grams of carbohydrate and the glycemic index, it has many of the same flaws. And underlying both the glycemic index and the glycemic load is the perception that carbohydrates are always the primary suspect, even though countless civilizations have thrived on diets rich in staple starches.
To many of today’s consumers, “low-carb” means following the Paleo diet. In its purest form, this diet advocates avoiding all starches (grains, legumes, and potatoes) based on the mistaken notion that starches were not important sources of energy for our ancestors, who instead thrived on a diet rich in animal products supplemented with fruits, vegetables, nuts, and seeds.
This claim is based largely on estimates of what modern-day hunter/gatherers (proxies for our ancestors) eat. But the science is far more complicated than the carefully crafted public face of the diet.
It is a false interpretation of the ancestral diet to claim starch was unimportant to the evolution of Homo sapiens. According to Harvard primatologist Richard Wrangham, PhD, so-called “underground storage organs”—roots and tubers—supplied a significant energy source in Africa during the time of Homo erectus and earlier.
The discovery of mortar and pestle artifacts used to grind grain shows that the skill appeared around 40,000-50,000 years ago. This provides a strong suggestion as to the importance of these foods tens of thousands of years prior to cultivation. Since endurance suffers without a starch staple in the diet, most Paleo advocates “cheat” with carbohydrates on a regular basis.
The romantic picture of hunter/gatherers living in their natural environment on diets high in meat and saturated fat, free from any circulatory complications, does not match reality. In 1972, a group of US researchers studied the Masai, a pastoral African people who have survived for thousands of years primarily on meat and milk.
Despite the high intake of animal protein and saturated fatty acids, the cholesterol levels of the Masai typically are low. So too are instances of heart attack. However, autopsies performed on men between the ages of 10 and 60 who died suddenly of trauma or acute illness revealed that the Masai had advanced atherosclerosis, just like elderly people in the US. This drove the researchers to seek what was protecting the Masai from heart attacks.
It was discovered that Masai in excellent physical condition had arteries so large that the opening was not compromised by the advanced atherosclerosis. Exercise certainly helps to prevent heart disease by increasing circulation to the heart. However, the diameter of the arteries also increased with age. This could be considered natural profusion of the heart, rather than by way of stents, clot-busting drugs, or bypass surgery. In fact, it appears to be a result of a combination of exercise and natural selection.
The Masai diet is unquestionably atherogenic. However, place a population in a natural environment over thousands of years on an atherogenic diet and nature apparently favors those individuals who have naturally larger arteries enhanced by exercise. Notable is the fact that the Masai are not protected by healthy lipid profiles.
The fact that a particular diet could help lower blood lipid profiles might not be enough to prevent the buildup of plaque on the arteries. Studies have repeatedly demonstrated a reduction of atherosclerotic plaque with diets rich in plant protein and complex carbohydrates, along with fruits and vegetables.
Staple starches (whole grains, legumes, roots, and tubers), along with plant sources of fat and protein (nuts and seeds), are nutrient-dense ingredients of virtually all healthy traditional cuisines. Importantly, they haven’t been staples of the modern “Westernized” diet, particularly in the past few decades. It’s no coincidence that during this same period, rates of obesity and type 2 diabetes rose sharply.
A quick view of the USDA data on food availability, adjusted for loss, reveals yet another interesting case where scientific reality does not match public perception. In 1970, before the rapid rise in obesity and type 2 diabetes, the average American daily per capita calorie intake was just above 2,000. By 2010, average adult calorie intake rose to nearly 2,500 daily, while the average amount of activity plunged.
Two food groups that accounted for the vast majority of this increase were flours (not including rice products) and added fats and oils. The increase in sugar was less dramatic, peaking in 1999 and decreasing since then. Any dietary advice emphasizing produce-based foods will counter this nutrient-poor increase in calories.
Many food processors already are investing heavily in traditional dishes prepared from ingredients that consistently have been shown to provide protection from chronic diseases. These ingredients also are rich in micronutrients, such as antioxidants, vitamins, minerals, and co-vitamins. All these components are believed to support immune function and provide energy, while countering some of the effects of aging.
Two companies are taking the “holistic” approach to creating foods for a healthy diet. Tasty Bite Eatables Ltd. makes an extensive line of Indian and Asian meals. Each emphasizes staple ingredients such as whole grains, legumes, a variety of vegetables, and authentic spices rich in phytochemicals.
Amy’s Kitchen provides a vast array of vegetarian food items that combine whole grains, legumes, and vegetables, as well as organic dairy products. These are applied to formulations ranging from pasta dishes and pizzas, to soups, burritos, and vegetarian burgers made with mushrooms and walnuts. Soy proteins are featured, along with various nuts and seeds to extend the vegetarian protein choices.
These aren’t the only processors to recognize the complex value of nuts and seeds. Nuts of all varieties are associated with reduced risk factors for chronic diseases. They are favored as natural sources of vitamins, minerals, and beneficial fatty acids. They also have the advantage of a high satiety factor, offsetting their high calorie count.
Almonds, pistachios, cashews, hazelnuts, walnuts, and peanuts are rich sources of monounsaturated fatty acids, the dominant fatty acid in olive oil and avocados. Walnuts contain significant levels of omega-3 fatty acids. Seeds tend to be higher in protein than nuts, and are typically rich in trace minerals as well. Nuts and seeds also are great sources of selenium, a mineral that functions as an antioxidant.
As sources of plant fats, nuts and seeds are typically rich in vitamin E, a fat-soluble antioxidant that protects cell membranes. Vitamin E is not one compound but a combination of several compounds, including α-, β-, γ-, and δ-tocopherol and α-, β-, γ-, and δ-tocotrienols. They are strong antioxidants, with some studies showing tocotrienols being up to 400 times more powerful than tocopherols.
Tocopherols are one of the most widely used antioxidants in food processing.
There is solid scientific support for vitamin E playing a significant role in immune health. In humans, vitamin E works with coenzyme Q10 to enhance the antioxidant function of the latter compound. CoQ10 serves as an antioxidant and, in its primary role, is involved in the production of ATP from the food we eat. This makes the vitamin particularly interesting for weight management as it pertains to metabolism and energy.
The rise of vegetarianism and veganism is being driven by multiple factors, from health to ecology to social trends and even religious practices. And while a vegetarian subsisting on a 5,000 kcal day diet of candy bars, soft drinks, and sugary cereal will rapidly join the millions of overweight people needing to diet, it still is true that there is a lower chance of unhealthy weight gain on a balanced vegetarian diet.
Multiple studies covering decades of research support the conclusion that shifting to a healthful vegetarian diet can lead to weight loss. But for former meat eaters, what works and what can be maintained can end up at cross purposes. Luckily, manufacturers have been hard at work developing meat alternatives designed to provide low-calorie satisfaction to “fool” the carnivorous brain. (See “Plant Proteins and Other Fake-Outs” and “Flavorful Fake-outs” at www.preparedfoods.com.)
These meat analogs serve to add emphasis to the consumer trend of enjoying more whole foods including legumes, nuts, whole grains, fruits, and vegetables.
Companies such as Pinnacle Foods Inc.’s Gardein brand, Kellogg Co.’s Morningstar Farms, and newcomer Beyond Meat Inc. have created an array of impressive meat, poultry, and seafood analogs that make no apologies for mimicking dead animals.
A diet of whole foods could be the best support for the immune system. The immune system is just that, a highly complicated system, too complex to be “boosted” by any one ingredient. There is, however, much evidence that malnutrition in general places immunity at risk and some evidence that certain micronutrient deficiencies can alter the immune response in animals. Of particular concern are deficiencies in micronutrients such as vitamins A, B6, C, E, and folic acid, along with zinc, selenium, copper, and iron.
Traditional staples may also be rich in choline, a vitamin-like nutrient that serves many vital functions, from participating in cell membrane structure to neurotransmitter synthesis. There is not sufficient information to calculate an RDA for choline, so the Food and Nutrition Board of the Institute of Medicine, National Academy of Sciences, has estimated an adequate intake figure. The deficiency was not recognized until recently.
The recent rise in the use of white flour, added oils from fryers, and increased use of sugar (although not at the level of public perception) at the expense of traditional ingredients consistent with reduced risk factors for disease leaves a satiety void.
The poorer the vegetable staples of the diet, the greater the tendency to fill the satiety void with animal foods, especially processed meats and foods rich in saturated fatty acids. This creates a vicious cycle that places both health and sustainability at risk.
Popular diets don’t remedy these risks, they exploit them, thereby complicating what should be a simple guide to healthy eating. As processors move into developing this next generation of diet foods and beverages, they surely will find that focusing on the long-term health goals of consumers will also pay off in meeting long-term goals for success.
Originally appeared in the March, 2017 issue of Prepared Foods as Diet Dilemmas.
Vegetarianism and veganism are known to help promote weight loss within an overall healthy diet, and the numbers of consumers adhering to these disciplines is growing rapidly. But should food manufacturers gear up for a stampede of vegans rushing to the market for meat alternatives? While meat-free lifestyles are increasing, their adherents still represent a small segment of the population. Still, manufacturers should be mindful of another movement that is proving to be huge. “Less is more” is the word of the day, and the main goal is sustainability. A large population eating significantly fewer animal products and many more plant-based foods can have a greater impact on the environment than an increase in the relatively small population of vegans. Investment in plant proteins, legumes, nuts, and seeds, high-protein grains like quinoa and teff, along with soy protein, algae, and others cannot be considered chasing a fad, but rather an acknowledgment of old traditions. Traditional diets are replete with complementary plant food proteins. In most traditional cuisines, animal foods as protein sources are extended by the use of plant proteins. Although sustainability is not built into US dietary guidelines, it is gaining acceptance worldwide. (In fact, sustainability is built into the dietary guidelines of the Netherlands.)
There is increasing evidence that a diet that incorporates probiotic foods can lead to weight loss and more effective weight management. In addition to naturally probiotic-rich foods and beverages, such as yogurt, kefir, kimchee, certain cheeses, and other fermented products, ingredient companies have been developing hardy and effective strains of the friendly bacteria designed specifically for use in products previously unable to support probiotic life. In products ranging from chocolate confections to nut butters and from high-acid beverages to cereals and baked goods, probiotic bacteria are becoming highly versatile ingredient choices for product developers. One study published last November in the journal EBioMedicine found that the strain Bifidobacterium animalis ssp. lactis 420, alone or in combination with the prebiotic fiber polydextrose, “reduced body fat mass, trunk fat mass, waist circumference and energy intake compared to placebo in those participants who adhered to the study protocol over the six-month intervention.”