Image courtesy of vegetables.co.nz

You’d have to be living under a rock if you haven’t heard the term “clean eating” being bandied around by diet advocates and eager adopters. But what does it mean?

There is no official definition.

Depending on your personal beliefs and food philosophies it can mean anything from avoiding meat, dairy, or grains to eating a 100% organic diet. The only universally consistent principle seems to be the avoidance of highly refined or processed foods.

The term is often used in conjunction with other diet buzzwords- “paleo”, “primal”, “caveman” and “wholefood” diets.  This complicates the issue even further, and illustrates nicely that even the die-hard followers of these diet movements cannot clearly explain the differences between the various terms.

And now, like with every other diet trend, the food marketers are jumping on board. Lion Dairy and Drinks have released a new range of lower sugar soft drinks, called Hopt Soda, which has the quite meaningless tagline “Drink Clean.” I’ll hand it to them- it’s probably the most on-trend marketing puffery I’ve seen this year. It’s an implied health claim without actually being a health claim. If anyone challenged them their legal team could simply argue it means the product is hygienically prepared.

It probably sounds like I dislike the term. But that’s not entirely true. If anything I’m jealous that the credible nutrition experts, such as registered dietitians and nutritionists, didn’t come up with it first.

As I dietitian myself, I think you’d be hard pressed to find a dietitian who doesn’t promote an eating pattern that focusses on natural whole foods such as fruit and vegetables, and recommends minimising highly processed foods.

Effectively, this version of “clean eating” is what dietitians have been recommending for decades. We just haven’t had the marketing panache to give our dietary messages a buzzword that can be adopted with a cult-like following.

Maybe we can come up with the next one?

Image thanks to FreeDigitalPhotos.net

The universal call to increase the consumption of fruits, vegetables, higher fibre foods and seafood, coupled with tightening family budgets, means that a study published recently in the Journal for Nutrition and Food Sciences is highly relevant.

The study looked at the nutritional qualities and relative cost of canned foods, and reassuringly found that canned foods provide sound nutrition at an affordable price, in a convenient format.  Specifically much-needed key nutrients, such as fibre, protein, folate, vitamin C, and vitamin A were shown to be significantly preserved in a range of canned foods.

The nutritional findings are in line with research undertaken here in New Zealand about 10 years ago, but the latest study went an extra step by evaluating affordability on a price-per-serve basis against fresh, frozen and dried counterparts.  The affordability measures took into account preparing and cooking time, and also energy usage.

The study looked specifically at canned beans, corn, mushrooms, peas, pumpkin, spinach, tomatoes, peaches, pears and tuna; comparing then with their fresh counterparts.

Two examples of the findings were:

• Tomatoes – It is nearly 60 percent more expensive to obtain dietary fibre from fresh tomatoes as from the same portion of canned tomatoes.
• Corn – When looking at purchase price alone, fresh corn is less expensive than canned or frozen. However, when the cost of waste (most notably the cob) is factored in, as well as time to prepare, canned corn offers the same amount of dietary fibre with a 25 percent cost saving compared to fresh and the same amount of folate with a 75 percent cost saving compared to fresh.

The NZ Nutrition Foundation (NZNF) commented on the relevance of the findings, as they come at a time when many families are struggling to put healthy food on the table because of limited budgets. It also makes the point that canned foods ensure essential nutrients are more accessible to consumers, particularly those with limited storage, preparation facilities, limited time, skill or interest in preparing fresh foods.

I find this heartening, at a time when so many of our current foodie programmes put great emphasis on the use of fresh fruit and vegetables.  I fear this may be setting the bar too high for many kiwi families who are struggling to make ends meet.  We now know that canned foods do deliver the goods nutritionally and needn’t shy away from the limelight, in the informed kitchen.

It got me thinking that scepticism vs denialism is another way of describing a theme often addressed in this blog.  I consider myself a sceptic – meaning that I take an objective approach to the evaluation of claims – but I also find that a bit of commonsense goes a long way.  Deniers, on the other hand, have a position (or end goal) staked out in advance, and sort through the data employing “confirmation bias”.  This is defined by New Scientist as “the tendency to look for and find confirmatory evidence for pre-existing beliefs and ignore or dismiss the rest”.  Whether sceptics agree or disagree, we can debate the issues like grown ups.  Dealing with denialism feels more like trying to rationalise with a toddler having a tantrum.

It’s easy to think of denialism as an old fashioned notion, driven by zealots such as anti-evolutionary theorists or those who believed the Earth was flat.  But no – denialism is alive and well in our modern world.  We’ve all heard of climate change and vaccination deniers.  New Scientist provides useful perspectives on these examples, as well as deniers of the ill health effects of tobacco, the existence of AIDs and those who believe pandemics such as swine ‘flu are developed and released by pharmaceutical companies.  I can add more examples to this list based on personal experience in the food and health area.  Those who are convinced that:

• obesity is caused by single foods or beverages (and that this is a conspiracy of global food companies).
• anti-tobacco tactics directed to certain foods are the best option to combat obesity.
• specific approved food additives or ingredients cause illnesses ranging from autism to cancer (and that this is a conspiracy of both food companies and food safety organisations).
• there are no adverse health effects of high salt diets at a population level.
• it’s acceptable to deliberately design research studies to prove a point or handpick research results to suits their means, rather than taking a more objective view.

Your typical denier often has the public’s sympathy because they’re the “underdogs, fighting the corrupt elite”.  They often occupy the moral high ground for this reason.   And the media love the extreme viewpoint they offer so they have a natural public stage.  Regulators, businesses and governmental organisations do not have the luxury of being able to handpick evidence to suit.  They have to be objective, so they often come off looking non-committal, or at worst, defensive, when facing denialists in public.

In my digging around for material on this subject I also found this delightful quote by Richard Asher, published in The Lancet in 1959.

“It is important to realise that ideas are much easier to believe if they are comforting and that many clinical notions are accepted because they are comforting rather than because there is any evidence to support them. Just as we swallow food because we like it, not because of its nutritional content, so do we swallow ideas because we like them and not because of their rational content.”

I believe this rings especially true today and I’d love to hear some more examples of denialism that you’ve come across.

In olden day cowboy movies the do-gooder cowboy heros wore white hats.  Recently the term “white hat bias” was coined to describe bias in scientific research on obesity (the subject of much nutrition research at present) which leads to “distortion of the published information in the service of what may be perceived as righteous ends”.

A commentary in this month’s International Journal of Obesity discusses this phenomenon and analyses examples.  Particular bias on topics related to weight, nutrition and the food industry were shown, especially a tendency to distort information about products such as sugar-sweetened beverages or practices like breastfeeding, regardless of the facts, when the distortions are perceived to serve good ends.

The authors examined the areas of citation bias, publication bias miscommunications in press releases and the inappropriate or questionable inclusion of information.  Analysis of specific research papers in the areas of reporting effects of sugar-sweetened beverages on body weight and the protective effects of breastfeeding were included.

The analysis showed that less than one-third of the papers citing the beverage studies accurately reported the overall findings, and more than two-thirds exaggerated evidence that reducing sugar-sweetened drink consumption reduced weight or obesity. The researchers also found several examples in breastfeeding studies in which the white hat authors selectively included some data and discarded other research to support the theory that breastfeeding decreases the risk of obesity.

For both the beverage and breastfeeding research, the resulting data was more likely to be published when it showed statistically significant outcomes. Studies with outcomes that did not show sugar-sweetened drinks to be bad and breastfeeding to be good were less likely to be published.

Notably, this bias appeared in studies not funded by industry, raising questions as to the motivation on non-industry funded research.  Interesting; since for many years health lobbyists have also sought to disqualify the results of industry-funded research.

Some researchers like to demonise certain products or defend practices with a kind of righteous zeal.  Whether this is intentional or unintentional, it’s simply wrong to stray from truthfulness in research reporting.

So, perhaps with the best of intentions, scientists are actually distorting the available evidence and losing sight of what science is about – the disciplined, objective observation, collection and documentation of findings.  The authors refer to white hat bias as “eroding the foundation of scientific discipline”.

Last week I went to a seminar in Wellington which discussed similarities between the food industry and tobacco industry, and was reminded of the potential dangers of White Hat bias being used here in New Zealand.

]]> http://www.foodinfo.org.nz/white-hat-scientists/feed/ 1 http://www.foodinfo.org.nz/what%e2%80%99s-driving-us-to-drink%e2%80%a6and-what-are-we-drinking/ http://www.foodinfo.org.nz/what%e2%80%99s-driving-us-to-drink%e2%80%a6and-what-are-we-drinking/#comments Mon, 30 Nov 2009 01:47:38 +0000 Donnell Alexander http://www.foodinfo.org.nz/?p=127 Read More ›]]> Recently I had the privilege of hearing one of my all time dietetic gurus, Linda Tapsell from Wollongong University, speak about how we relate to beverages.  Alongside her, Claire Richards from Coca-Cola Oceania shared some fascinating insights into New Zealander’s attitudes to drinking.  And Caryn Zinn expertly summarised issues on hydration in sport.

When it comes to successfully encouraging people to make healthier beverage choices, each and every speaker stressed the importance of working with individuals, rather than making broad general recommendations such as “drink water and low fat milk”.

What people expect and need from different beverages is extremely varied, which explained to me why it’s unrealistic to expect people to switch from one set of beverages (with similar attributes) to another set of beverages (with completely different attributes in the mind of the consumer). 

For example, if you’re out for a good time with your mates you’re about as likely to order a glass of milk as you are to be wearing pyjamas.  What you want is a beverage that’s associated with socialising, not one that’s associated with, say health and nutrition.  There is a time and place for everything.

Those underlying needs associated with certain life situations don’t change, but moving to a healthier option which addresses the same underlying need within the same situation is far more likely to work.  For example in the scenario described above, recommending that people order a diet soft drink if they’re watching their calorie intake, rather than a sugar containing soft drink, might actually be likely to work.

That would be fine, were it not for another shocking fact I picked up at the same seminar: New Zealanders drink mostly tap water (nothing shocking in that), but the second most widely consumed beverage in New Zealanders (ranging from 12-69 years of age) is …wait for it….beer!  So in fact, most people in the above scenario will opt for a beer anyway!  Diet beer anyone?

This sets my mind reeling at the calories we Kiwis must consume from alcohol.  It baffles me why all dietary energy sources do not require nutrition labelling and packaged alcoholic drinks are a long overdue candidate for this. 

Thanks to the NZ Nutrition Foundation and Coca-Cola Oceania for making this event possible.  Linda and Caryn’s presentations should both be up on the Nutrition Foundation’s website shortly.

A recent evaluation of the zoning strategy employed by authorities in Los Angeles, banning new fast food establishments in order to address the excessive obesity problem in South Los Angeles, indicates that strategies like this are unlikely to achieve their goals.  The main reasons for this failure are outlined at the end of this posting.

There is an assumption both in the US and NZ that so-called “toxic food environments” exist, in which poor and minority neighbourhoods are overrun with fast-food chains, causing higher obesity rates.

While the majority of fast food may not be nutrient dense, it is conceivably less obesogenic than food eaten at full-service, sit-down restaurants in the US.  This is because it is less calorie-dense, due to greater portion control and a shorter “food exposure time”.  In American sit-down restaurants the serving sizes were found to be 2-4 times greater than recommended, and in this environment people are more likely to also order dessert and be topped up with free sugary drinks throughout their stay.

There are some big differences between the US and NZ.  Most obviously, our much maligned intake of soft drinks does not come anywhere near the gallons consumed per capita in the US – especially by teenagers and young adults.

I propose that the great kiwi institution of fish and chips – still the country’s most eaten takeaway, is probably more obesogenic than many fast food chains.  A piece of battered fish and standard scoop of chips from one of these places is enough to feed my whole family – for several days sometimes!

But most importantly, as the L.A. study illustrates, we just have too much food around us all the time.  Establishments providing meals are only one small part of a food environment where it’s possible to indulge our taste buds ceaselessly if we so desire.  In my opinion it’s this constant nibbling (or scoffing) that’s by far the biggest problem – even more so than what’s being eaten.

Findings of the L.A. zoning evaluation study:

1.    Upon analysis there were actually fewer fast food outlets in South LA per capita than in other parts of L.A.
2.    There was a much higher density of small grocery stores (I guess similar to our dairies) in South L.A. compared to other parts of L.A., and a lower density of large supermarkets.
3.    Discretionary calorie intake, higher in South L.A. than other parts of L.A., was mainly from foods and beverages widely sold in non-food establishments as well (eg, vending machines, car washes, bookstores, laundromats, offices, etc).
4.    The proportion of the population having the recommended number of fruit and vegetable servings per day, or getting the recommended amount of exercise was no different in South L.A. compared with other parts of L.A.
5.    People in South L.A. were more likely to walk or take public transport to do food shopping, while this is unreported in other parts of L.A.

A new computer system

In principle it sounds like a great idea but on the other hand, are we not depriving them of an opportunity to use their own decision making skills, in what would surely be a somewhat controlled environment?

As with most things I guess it depends on how we put it into practice.  Food police parents are likely to be pretty vigilant at home and will aim to encourage the same at school.  Many would argue that the school cafeterias should not be offering ‘inappropriate’ food choices anyway.  But those children who want to beat the system will always find a way, whether it’s at school or elsewhere.

At the other end of the scale there are the permissive parents who, given their more relaxed attitude are probably not going to worry too much anyway – at school or home.  And somewhere in the middle – my personal favourite – one hopes that common sense prevails.

For younger children I am sure that it could be a useful tool to help them learn about making healthy food choices.  But as they get older surely we need to offer them the chance to make their own decisions?  Yes there will be some downsides but with a good foundation they will eventually realise that eating only treat foods isn’t all that fulfilling.

I often wonder if parents of children who are growing rapidly are in fact offering sufficient high energy density foods to meet their needs.  A teenage boy for example can burn twice the energy of a sedentary adult male.  A desire for high energy snacks is just as likely to be due to a genuine need for energy in some as it is due to poor decision making in others.

On the other hand we know from the national nutrition surveys that as children get older and begin to exercise more free will, the overall nutrient intake changes – and not usually for the good. In particular consumption of dairy, fruit and vegetables goes down.

So what is the best way to encourage children to choose the right food and beverages at school?  Should we not be putting our energy into making sure what is on offer is appealing, tasty and good quality – nutritionally and aesthetically?

So what happens when we don’t like the results we get from research?  I was astounded to read recently about the Soil Association’s response to a piece of research which, added to existing research in this area, found that organic vegetables were not nutritionally superior to their standard counterparts.   Peter Melchett, policy director at the Soil Association, said:

“We are disappointed in the conclusions the researchers have reached. It doesn’t say organic food is not healthier, just that, according to the criteria they have adopted, there’s no proof that it is.”

Likewise, on last night’s TV3 6 o’clock news, after an article highlighting recent research findings on sunbeds and melanomas there was a comment by a man representing the sunbed industry.  He said people need to weigh up health risks such as this with all of the many health benefits to be gained from using sunbeds.

What?

As a busy person, getting to lie down and relax for 10-15 mins a couple of times a week might be good for my stress levels I guess.  Aside from that I cannot imagine what he means by health benefits – especially since what you’re weighing it against is a 75% greater risk of getting melanoma, if you’re under 30 years of age.

My point is that research is research.  While statistics can be manipulated to some extent, the balance of evidence is the balance of evidence.  If there is equivalent quality research to refute the findings and recommendations from other research this should be articulated.  If not, accept the facts for what they are.

While Tony Ryall argues that work in the areas dropped from the previous health targets is still important, I can only assume it’s not quite important enough to be a targeted priority.

The way we eat affects our health as a nation enormously – and in more ways than just our physical health.  I don’t think anyone would disagree with that.  What seems to be up for debate is where the responsibility lies for what and how people eat.

When Tony Ryall says that DHBs should not be held accountable for ensuring people eat their fruits and veggies, I tend to agree with him.  When public health experts say that people need a supportive environment to make healthy choices, I also agree with them.  Surely as a community we all need to play a part in creating a supportive environment, including the DHBs.  While the teams of experts within DHBs are doing a great job, they can’t achieve this on their own.

Most major food manufacturers and marketers are voluntarily taking significant steps to improve the nutritional compositition of their products and are playing their part in recommending responsible dietary consumption.  Having said that, some food manufacturers and retailers could definitely focus more on improving the nutritional content of their offerings.  For example, my local café serves very indulgent meals to its regular customers and it’s hard to find a menu item that doesn’t provide more fat/salt and/or sugar than what is desirable on a regular basis.

But people vote with their stomach when it comes to food choice, and those prioritising their physical health over everything else are sadly few and far between.  Making fruit and vegetables available, tasty, accessible, desirable, easy to prepare and affordable is the real task at hand, and no one should expect DHBs alone to be held accountable for this – just because they have to pick up the bill for obesity.  We all need to be accountable, but the Minister’s announcement may not help to underscore the importance of this.

Given the newness of this space to the business world and the rapid development of new social media platforms, the knowledge and skill level of people participating is wide and varied.  As qualified scientists, nutritionists and food industry experts we often find it challenging to accept the opinions of the new breed of influencers who are moving into this space.  But there is no question; their opinions are influential.

It’s therefore even more important to jump in and get involved.  The on-line social media universe is really only in its adolescence and we know how difficult teenagers can be to understand. But when they do grow up into more mature adults the real benefits become apparent.

There are also some new rules for interaction and for most people the best way to start out is simply to explore, participate, listen and learn.  I heard someone recently liken the rise of social media networks to the advent of the motor car.  When cars were new we all used to dress up and enjoy the journey, regardless of the destination.  Now that they’re an everyday necessity we see them as a means to an end.  So now’s the time to be enjoying your journey with social media – and you will be pleasantly surprised at what you discover.

There are endless numbers of food-lovers blogs out there.  Some of the health and nutrition related ones we monitor regularly are listed on the blogroll to the right of the page, and some good local information sites can be found amongst the links.  Please feel free to post your own favourites in the comments box.  We’re especially keen to know more about other nutrition and health blog sites from within New Zealand.