Americans are getting heavier—rates of obesity have doubled in the last 30 years—and along with that comes an epidemic of diabetes, cardiovascular disease, and cancer. This is quite clearly connected with our modern culinary proclivities and their perfect-storm partners, our crazy lifestyle, stress, and lack of sleep. What is alarming about this, aside from the massive health crises driven by our very deficient diets, is that a 2011 Consumer Reports survey found that 90 percent of Americans believe they are eating a healthy diet.
If Hippocrates were here, my guess is that he’d remind us of what he said so long ago: “Let food be thy medicine and medicine be thy food.” Unfortunately, intervention-by-vegetable is still the exception to the rule, medically speaking.
Given the way our medical system is currently structured, this lack of food-based intervention isn’t too surprising. Doctors receive very little nutritional training in medical school, and what they do receive “has almost no clinical application,” according to Joel Fuhrman, MD.
Which brings us to the seminal question: We ate ourselves into this mess—can we eat our way out of it?
Plates over scalpels: the micronutrient story
An outspoken doctor from New Jersey, nutritarian diet guru Joel Fuhrman is nearly 60, though he doesn’t look it. (Which, I guess, is the point.) He is lean and muscled, in excellent health, and has abundant energy.
When he was growing up, Fuhrman’s father owned 10 shoe stores in New York and wanted his son to take over the business, but even in his early 20s Fuhrman’s passion was nutrition. As a member of the US World figure skating team, Fuhrman was competing at a very high level and learned to eat to fuel his performance. Around that time he watched his ill father read diet books and get well himself. These two factors gave Fuhrman a chance to see the intimate connection between diet and health firsthand. He went to medical school with a desire to focus on nutrition and has since built a practice of food-based intervention. His ideas really came to the public eye with the 2003 publication of Eat to Live, a #1 New York Times best-seller.
He believes the root cause of all of these chronic diseases is simple: good health requires eating a large amount of fresh fruits and vegetables, and the American diet couldn’t be further removed from the ideal. Americans, on average, eat 60 percent processed foods and 30 percent animal products, leaving a meager 10 percent for raw, unprocessed fruits and veggies. Of that 10 percent, more than half comes in the form of white potatoes.
But here’s the good news. According to Dr. Fuhrman the answer to “can we eat our way out?” is a clear, resounding yes—though it is going to take discipline, resolve, and a dietary about-face to do it.
To understand how this is possible, first we must delve into the nitty gritty of nutrients, which will both show us where we went astray and point the way back. At the most basic level there are two types of nutrients: macronutrients and micronutrients. Often when we’re reading the label to evaluate a food we’ll check out the macronutrient profile: how much protein it has relative to the amount of fat and carbs. Macronutrients contain calories and are, of course, vitally important to our well-being. Without an adequate supply of macronutrients we would starve.
Undervalued but arguably more important are the micronutrients like the 14 essential vitamins, 16 essential minerals, and thousands of phytochemicals. These do not contain calories, and our body needs them only in tiny amounts, but their role in maintaining our health cannot be overestimated. Phytochemicals, critical though they are, were only discovered about 20 years ago.
This goes a long way toward explaining why many people underestimate how bad most processed foods are for us. Fuhrman points out that “adding vitamin C to Koolaid and riboflavin to Coco Puffs gave people the idea that it’s OK to eat refined foods.” That notion that processed foods are OK does not take into account phytochemicals and the fact that all the vitamins and minerals are important. An extra 100 IUs of vitamin A does not a health food make.
(It’s worth noting that there are a large number of processed foods out there masquerading as health foods. Gluten-free items are one example: just because something doesn’t have gluten in it does not make it healthy. Rather than focusing on what food doesn’t have, let’s focus on what it does have—when in doubt, the less processed, the better.)
In his book, The End of Diabetes, Fuhrman describes the significance of phytochemicals. “Now we know that the major micronutrient load in food is not vitamins, not minerals, but phytochemicals. These substances pack a powerful punch. They function to improve human health and longevity. We found the fountain of youth, and it was right in front of our noses all along. There are tens of thousands of phytochemicals in natural, whole, vegetable-based foods. These plant nutrients are essential in helping protect you from disease. If you are already sick, they will help you recover.”
If Fuhrman and the recent nutritional science is correct (and he has a 20-plus year history of reversing chronic disease to suggest he is) then diet really is the linchpin for all these chronic diseases. If the phytochemicals in food are the crucial missing ingredient in health, everything comes into focus. The standard American diet provides us with four percent of phytochemical-rich fruits and vegetables. Four percent. Processing removes the delicate phytochemicals found in raw produce, and animal products don’t have them in the first place.
Though not generally prone to flowery language, Fuhrman is fond of the metaphor of a “full symphony of micronutrients in veggies, beans, nuts, and seeds.” He goes on to say, “Now we know that every tomato has 1,000 nutrients in it. Every head of cabbage, every piece of lettuce, every cucumber, every bean or berry or sprout has hundreds or even thousands of nutrients that are so important to protect our health.”
The symphony metaphor really cuts to the heart of it. We discovered macronutrients back in the early 1800s (Dutch organic chemist Gerardus Johannes Mulder first used the term protein in a medical journal in 1838). Sometime after vitamins and minerals were discovered some 100 years later, we ramped up production of processed foods—with plenty of fat, protein, and calories!—fortifying them with a few vitamins. We cut out the symphony, settling instead for four-piece chamber music.
Supplementing can be helpful, but is certainly not a panacea. Fuhrman maintains that the makeup of nutrients in unprocessed fruits and vegetables is so complex that it can’t be replicated synthetically—and why would you need to when it is plentiful in green vegetables?
A nutritarian diet
Fuhrman’s way of eating, as you no doubt suspect by now, is a radical departure. His “nutritarian diet” is governed by a simple equation, H = N/C. In this equation H is health, N is nutrients (more specifically micronutrients like vitamins, minerals, and phytochemicals), and C is calories. This, of course, isn’t an equation that you are to plug numbers into—rather it’s a way to think about eating. If you want to eat healthy (or maximize H, in terms of the equation) you would try to eat foods that are high in nutrients and low in calories. Granted, that won’t be all your foods, but you want to trend in that direction.
He devised ANDI (aggregate nutritional density index) scores as a way to rank common foods. The scale runs from one to 1,000, with 1,000 being a perfect score. As you might imagine, calorie-dense foods will naturally rate lower on the scale: calorie-rich, low-or-no nutrient foods round out the bottom.
(ANDI scores are helpful to shoppers as information on these essential micronutrients is not on standard food labels. Whole Foods started posting ANDI scores in 2010—their founder and CEO, John Mackey, said, “It’s not enough just to sell high quality food. We have to educate people. We have to teach them how to eat better, because people don’t know.” And it worked: in the first month using the ANDI scores, sales of produce increased by double digits and dark green sales went up 25 percent.)
Eating healthier, then, means eating foods with higher ANDI scores. Fuhrman’s food pyramid has vegetables (half raw, half cooked) at 30 to 60 percent of the diet, and that is counting by calories, not by volume. Since vegetables are low in calories relative to other foods, this means eating heaping helpings of greens each day—he recommends one pound of cooked vegetables per day and one pound of raw. This is quite possibly the only time people have gone on a diet and not been able to finish their dinners because they were too full.
Eggs, fish, and fat-free dairy, by contrast, account for less than 10 percent, and beef, sweets, cheese, and processed foods are to be eaten “rarely.” Rounding out the middle are fruits; beans/legumes; seeds, nuts, and avocados; and whole grains and potatoes.
Some commonly cited health foods don’t make the list, including salmon. “I think that people shouldn’t even eat any salmon because it’s such a toxic food in the condition it’s raised in China today. I think it’s a very dangerous food to eat…Farm-raised salmon has more residual toxic residue in the tissue than even would be in commercially raised beef. We have to eat less animal products.”
That question raised an interesting issue: with all these veggies and quite a lot less meat and eggs, how are we supposed to get enough protein? “Eating too much protein is powerfully disease causing. [The idea of eating massive quantities of protein] is based on science that was done over 100 years ago.” Fuhrman said natural foods like whole grains, beans, nuts, and green vegetables have 35 grams of protein per thousand calories, so if you were to eat 2,000 calories, you’d get 70 grams of protein. “We have to avoid overconsuming protein. Probably the biggest factor leading to an early death in this society is the excessive consumption of protein.”
Is this the cure for everything?
OK, maybe not everything. Fuhrman says there are a few diseases that are truly genetic in origin and will require medical care. Beyond that, most illness is the result of nutritional folly. “Doctors are making people think these diseases are inevitable, the consequence of aging, and that our savior is doctors and drugs and surgeries. People don’t see that they’re in control of their health destiny and take responsibility for their health and maintain a healthy lifestyle…I mean look at me and my family. We don’t require medical care. Nobody goes in—we don’t take drugs and go to doctors and get exams. My wife and myself (I’m almost 60 years old) don’t take drugs, go to doctors, get medical care.”
He maintains that we are overweight simply because we are not eating the right foods—yes, it is of course good to exercise, but you can be thin without a whole lot of exercise. “Overweight humans are around because we’re not eating real food. Plaque hardening the arteries and wall is completely unnatural. Every heart attack death is completely unnatural, the result of eating this diet we just described that’s too high in processed food and animal products.”
Reviews of Eat to Live and internet forums are full of people who have lost major weight (some over 200 pounds), reversed type 2 diabetes, brought blood lipid profiles into a healthy range, and safely stopped taking all of their medications simply by adopting a new way of eating. Other healthy habits, he observes, seem to come as a matter of course to many of his patients. Exercise will feel good, and so you’re more likely to do it. “A healthy body behaves in a way that’s more normal. You sleep better, you feel better, you’re better emotionally, better productivity, your brain functions better. All these things happen with better health.”
OK, so practically speaking, most people aren’t going to down two pounds of veggies a day. If you are in a fight for your life and need to make vast improvements to your health, then by all means, make drastic changes. For those of us who are generally healthy and want to preserve our health and enjoy being active for a very long time, the simple takeaway here is to minimize consumption of the foods that are, let’s say, less than optimal, and maximize consumption of the foods highest on the ANDI list. However much kale you’re eating, eat more.
So, is this the cure for everything? If not the cure, at least the prevention.
Now please pass the kale.
By Dick Benson