Eat Food, Not Nutrients: Why Healthy Diets Need a Broad Approach

Plums (YelenaYemchuk/iStock)

There seems to be a narrowing gap between studies about diet, nutrition, and health. And each starts another conversation about trans versus saturated versus polyunsaturated fats, or this diet versus that, or as is today’s case, fats versus carbohydrates.

In a paper published Aug. 13 in the journal Cell Metabolism, researchers found that when 30 percent of a day’s kilojoules [calories] were restricted by cutting fats (diets with a higher intake of carbohydrates), participants in their study lost more body fat compared to when the same amount of energy was restricted by cutting carbs (diets with a higher intake of fat).

This study used a type of meticulous metabolic research that is expensive and unsuited to lengthy periods, but valuable for exploring the physiology of reducing equal dietary contributions from fat or carbohydrate. But like much dietary analysis, it may be shining a light on the wrong issues altogether.

The Good, the Bad, and the Ugly

The most important aspect of any diet is that it should be practical and healthy enough to follow for the rest of your life. There’s no magic bullet for weight loss. While some people claim they find it easier to cut out foods high in carbohydrates, others find it easier to avoid high-fat foods.

If you need to lose weight, cutting down is what helps. But few people can stick to any extreme diet for life, so what you substitute is just as important as what you cut out—especially for long-term health.

Choices based only on macronutrients (foods required in large amounts in the diet, such as fats, carbohydrates, and protein) miss important aspects of many foods and open the diet to imbalance.

Some foods are more even problematic. Most fast foods are high in saturated fat and salt, and also lack dietary fiber. And they’re not only largely devoid of vegetables (apart from the odd pickle), but often displace meals that would have contained vegetables.

Biscuits, cakes, pastries, many desserts, and confectionery provide a double whammy with high levels of unhealthy fats as well as sugar and refined starches. Make that a triple whammy because most lack any nutritional virtue as well.

From Bad to Worse

Assumptions based on macronutrients are simply too gross to be meaningful. This is apparent in so-called meta-analyses based on a mixture of cohort and case-control studies that use different methods and time frames relating to what people eat and fail to report all aspects of the diet.

One review, for instance, claimed that saturated fat was unrelated to cardiovascular disease. But it ignored the adverse impacts of the foods that had replaced saturated fats and provided no information about the foods that provided saturated fat in the first instance.

Worse still, such analyses are prone to many errors. A long check of every reference used in that meta-analysis showed that the conclusion would have differed if 25 studies had either not been omitted or had been reported correctly (sadly, it’s paywalled).

Another recent review also failed to show any clear association between higher saturated fat intake and all-cause mortality, heart disease, ischaemic stroke or Type 2 diabetes, although the authors were unable to confidently rule out increased risk for heart disease deaths. They also noted that the certainty of associations between saturated fat and all outcomes was “very low,” which means we don’t yet understand the association between saturated fats and disease.

Hopefully, further research will distinguish between food sources of saturated fats; they are not all equal. There’s already good evidence that processed meats can have more deleterious effects than fresh meat. And that fermented dairy products, such as yoghurt and cheese, may also have health benefits and are distinctly different for heart-health risk compared to butter.

Swapping saturated fat for sugar or refined starches is worse than useless for preventing cardiovascular disease. But please direct criticism of foods where fat has been replaced by sugar at the food industry. Dietary guidelines have always recommended limiting sugar as well as saturated fat.

A Sorry State of Affairs

Unfortunately, in most developed countries, sugar consumption remains high while intakes of vegetables, legumes, fruits, nuts,  and whole grains are low. And while macronutrient intakes in countries such as Australia may look fine (31 percent of energy from fat and 44 percent from carbs), problems remain with the kinds and amounts of foods we consume.

Junk food and drinks were once consumed only as an occasional treat, but they now contribute significant portions of both adult and children’s diets—in Australia, 35 percent of adults’ and 41 percent of children’s energy intake. Confectionery and starchy, fatty, savory snack food intake have also increased significantly.

It really is time to focus on foods instead of wasting time on macronutrients. Australia’s Dietary Guidelines have made this change, as has the new simple Swedish equivalent, which emphasises sustainable choices. Norway and 20 European countries also take a food focus and the No. 1 point in Brazil’s enlightened guidelines is that diet is more than the intake of nutrients.

Consider the dozens of studies on Mediterranean diets, including randomized trials, where the fat and carbohydrate content vary, but the health value depends on particular foods: extra virgin olive oil, nuts, vegetables, fruits, grains, and legumes, and a low intake of highly processed products. The take-home message from these is that we need to stop fussing over macronutrients and think about foods.

Rosemary Stanton is a nutritionist and visiting fellow at the University of New South Wales in Australia. This article was previously published on TheConversation.com. Read the original article.