It’s Not All About About Grams and Milligrams

During one of my most frustrating experiences in the fun field of clinical dietetics, I had a husband and wife who were obviously under the influence of at least one potent substance, yell the names of random foods at me in a rapid-fire style for well over an hour. He had hypertension and she had diabetes. They yelled the name of random foods over each other in a very hyper, excited manner:

“Pickles!”

“No carbohydrate to speak of, but very high sodium.”

“Cereal!”

“She needs to count it as carbohydrate, but it’s pretty low in sodium.”

“Peanut butter!”

“What are you putting it on?”

This is what happens when we stop thinking of food as food, and start thinking of it as a pile of nutrients. People want two things from me:

  1. A list of “good” foods and a list of “bad” foods.
  2. A month worth of menus written out for them that they can follow to the letter.

I refuse to provide either of these except in very rare, desperate situations. Even if I do provide two columns of foods to eat and foods to avoid, it certainly won’t be labeled with the derisive “good” and “bad”. Most of everything written about nutrition focuses on individual nutrients: protein, fat, carbohydrate, fiber, etc. Sometimes this makes sense – like when you’re discussing a specific deficiency in someone’s diet. Sometimes, though, it does nothing but confuse and frustrate. For example, maybe you heard that a food was bad for you because it is high carb, and then the next day you read that it’s one of the richest sources of a nutrient that most Americans are deficient in. Should you eat it or not? Well, that’s not a yes or no answer. I can’t answer you unless I know your health history and goals, what else you eat in a day or week, and how much of it you plan on eating. This is why yelling “pizza!” at me and impatiently waiting for a yes or no answer is a failing proposition.

I can’t evaluate any food based on the sum of its nutrients. There is no calculation like: grams of carb + grams of protein/grams of fiber x B12 content + vitamin D content – fat content. Because that’s not how food works. This is why no supplement will ever compare to whole foods. You can shove all of the vitamins and minerals you want into a pill and it will never compare to what you would garner from eating a diet rich in fruits, vegetables, and whole grains. An Ensure supplement does not take the place of a well-rounded diet, but it will keep you alive if you can’t eat food. You can eat piles of kale and if you look at a nutrition facts label, you’ll think that you’re getting a lot of calcium, but a dietitian can tell you that you’re not, because the calcium is blocked by another substance in the kale – you are absorbing hardly any of it. Another example is that the fat in dairy products have much less of an impact on lipids that we would expect just by looking at the saturated fat content of it. Also, the almonds you’re eating might contain 160 calories according to the label, but you’re only absorbing 120 of them.

The bottom line is that we need to stop evaluating our diets by singling out nutrients and instead start looking at the big picture. As long as we continue to compartmentalize foods into categories of “high in (nutrient)”, “low in (nutrient)”, “good”, or “bad”, we are encouraging mass confusion and frustration. How does your day’s worth of food look? Is it bright and colorful? Are the portions reasonable? Does it contain a variety of foods from all of the major food groups? These are the sorts of questions that are the most meaningful to me, and they are ones that I rarely hear the answers to.

One comment

  1. Great article! There is so much confusing information and advice and it often doesn’t agree. I think we all know instinctively what we should eat and what to avoid. Moderation and reasonable goals are not as attractive as black and white thinking concerning food with it’s promised great health and physique in a short period of time.

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