Rethinking Healthy

photo credit | gourmetmetrics

Here’s the menu for a delicious, somewhat indulgent celebration meal I shared with family and friends in December. 

The meal reflects my kind of healthy. At least my kind of healthy before I decided to become a dietitian and learned how to measure healthy in grams of fat.

Over the last three decades we’ve been taught that palatability and healthy are polar opposites. Stealth health is a term still used today with regard to food. In other words, many people still believe that if food is obviously healthy, it’s not to be trusted.

That polar divide dates back to the 1990s. Research was going on prior to that date linking dietary fat to heart issues, but implementation didn’t happen until 1990.

That was the year congress passed the NLEA (Nutrition Labeling and Education Act). I was totally unaware that anything important had happened when I started my nutrition studies in 1993, the same year the Nutrition Facts Label appeared on packaged products. Buried under layers of regulatory cement, the new law contained austere nutrient-based criteria for healthy. Initially, the criteria were only applicable to packaged goods but by the end of the decade, the damage was done and the word healthy was successfully redefined as low fat.

The only items on my Christmas menu that qualify as healthy using these austere criteria are the baguette, the steamed rice, and the clementines. 

Low-fat is healthy dominated the first decade of this century. According to NBC news, when a group of researchers set out to understand the views of executives at major U.S. restaurant chains regarding the addition of healthy options to their menus, they were able to determine why by ensuring anonymity to the executive’s interview.

“If we put something on the menu and say it’s healthy, it’s the kiss of death,” one executive told the researchers.

The kiss of death was not limited to restaurant food. The first time I ran numbers on a mix of fresh mesclun with vinaigrette dressing, I discovered to my horror that my salad couldn’t qualify as healthy either. Too much fat. And too much saturated fat.  Olive oil has a higher fraction of saturated fatty acids than walnut or avocado or some of the other wonderful oils that can be used for a vinaigrette. In other words, my salad was even more unhealthy because I used olive oil.

Healthy as low-fat remained set in regulatory cement for 25 years. In 2015, however, something happened. That was the year the FDA sent a warning letter to the manufacturer of KIND BARS.

Most of the errors were minor technicalities except for one major misbranding error. The FDA requested that the manufacturer remove the word healthy from the label. The bars identified were made with nuts and because nuts are high in fat, the gram values exceeded those austere criteria set back in 1990.

KIND BARS complied but decided to file a citizen’s petition asking the FDA to re-evaluate. And the FDA agreed. The agency acknowledged the science related to recommendations for intake of dietary fats had evolved and, as per a 2016 guidance document, stated its intention to exercise enforcement discretion on an interim basis shifting the focus away from limiting total fat to encouraging unsaturated fats.

Et voilà. With the stroke of a bureaucratic pen, my menu got healthier. The menu as a whole just meets the current level 35% calories from total fat and my green pea soup, green beans, and rapini now meet this interim FDA criteria for healthy.

About the same time that the FDA published their interim guidance, a group of academic researchers working out of a university in Brazil published a document that took a completely different approach to healthy. 

Nutrition researchers and policy professionals in this country are used to breaking foods down into smaller and smaller components. Researchers have worked hard to develop hundreds of thousands food codes. Using these food codes, policy professionals can manipulate foods precisely and accurately in every conceivable combination of nutrients, micronutrients, or any other component.

The Brazilian academics reversed the process. They took a step back and developed a system that consolidated foods into only 4 groups: Unprocessed / Minimally Processed; Processed Culinary Ingredients; Processed Foods; Ultra-processed Foods. They called this food classification system NOVA.

Most chefs, home cooks, and food writers relate immediately to NOVA. Working with intact foods every day and thinking about food as a whole comes easy. A whole onion. A whole egg. A whole piece of Clothbound Cheddar.

My dietitian colleagues struggle with NOVA because they have been trained to think about food differently.

Dietitians are taught to think about food as nutrients. Onions are low in calories and contain no fat. Eggs are high in cholesterol. And even an artisan hand crafted cheese is high in saturated fat. In their view, NOVA seems crude, simplistic, and downright unprofessional.

Sometimes I feel like I’m caught between two coasts. I understand why NOVA upsets my zealous colleagues but I love the approach. 

And I love looking at my menu through the NOVA lens. Carefully sourced fresh ingredients. Enough salt, sugar, and fat to ensure palatability. Lots of freshly cooked vegetables and fresh fruit.

Here’s how my menu breaks down. All aromatics (onion, celery, carrot), garlic, fresh herbs, rapini, green beans, and clementines are obviously raw, minimally processed and belong in Group 1. Not so obvious foods included in Group 1 would be lamb shanks, spices, dried split peas, whole milk plain yogurt (pie crust), fresh egg (pumpkin filling), basmati rice, and refined wheat flour.

Olive oil, salt, butter (pumpkin filling), and sugar are classified in Group 2 as processed culinary ingredients. Canned whole tomato, canned pumpkin, and Bordeaux rouge are classified as processed foods and placed in Group 3. Only the mass-produced packaged baguette, the prosciutto, and the Armagnac are candidates for ultra-processed or Group 4.

And I’ve ended up coming full circle in my belief about healthy. It’s not that nutrients aren’t important. Nutrients are very important. But in the process of drilling down deeper and deeper, something basic has been forgotten. Let’s hope that something basic has not been lost.

Looking at the plate through a NOVA lens is a gentle reminder that food is more than the sum of its nutrient parts. And that palatability and healthy don’t have to be polar opposites.