In the past, I have discussed with relatively broad brush strokes the topic of the 5 so-called ‘Blue Zones’, regions of the world where folks tend to live freakishly long and productive lives. Today, I will be blogging about one specific Blue Zone, Sardinia. What captured my attention about the Sardinian Blue Zone is much the same as that of the other Blue Zones, i.e. none of the dietary components leapt out at me as a ‘secret elixir’ as independent variables in the longevity equation. Rather what stood out were lifestyle factors:
- The men and women both stay physically active throughout their lives and do not reduce their level of activity as they grow older, treating age strictly as a meaningless number. Life is to be celebrated with equal veracity at any age!
- The men walk daily over rocky terrain tending their sheep, they breathe in fresh unpolluted air, drink pure uncontaminated water, and make lots of vitamin D as they regularly expose their skin to sunlight, maintaining a healthy protective tan that safeguards them against skin cancer (believe it or not, the sun is not your enemy, Vitamin D deficiency is!).
- The women can be found tending the garden, washing clothes and milling grain, and of course going everywhere on foot, not by car.
- The Sardinians do not stress about anything and their pace of life is much slower than ours, quieter than ours, less distracted than ours (no iPhones!).
- They have a strong sense of family and community, cultivating loving enduring relationships till the end of their lives. No need for Facebook or Twitter. If they want to talk to someone, they do not text them or even call them on the phone. They walk over to their house and chat with them over a glass of wine.
So here’s my “Sardinian Theory”. If you’re not eating highly processed junk foods and fast food and you’re living a Sardinian-like lifestyle, as described above, then it does not really matter all that much whether or not you are eating the same exact foods as the Sardinians, e.g. Goat’s Milk, lamb, eggs, flat bread, sourdough bread, barley, fennel, fava beans and chickpeas, Milk Thistle and Cannonau Wine. You will be successful in maximizing your health and longevity mainly through a process of elimination, a recurring theme throughout most of my blog posts. In other words, it’s more about what you are not doing, i.e. stressing over trivial crap such as how many “likes” you got on your last Facebook or Instagram post, sleep depriving yourself to binge-watch your favorite shows on Netflix, sitting in front of a computer or television all day, then blowing yourself up in the gym for an hour 4-5 days a week (“Active Couch Potato Syndrome”), pulling up at the drive thru window of McDonald’s on your way home from work most days, overindulging in sweets, snacks and alcohol, etc. The Sardinians are healthy and long-lived primarily via exclusionary practices, not via an orthorexic obsession over every bite of food that they consume. They live happy and carefree lives, not because they are rich and have expensive toys, but because they know what truly matters in life: family, friends and one’s mental and physical health. Happiness is merely the byproduct of the aforementioned.
Live long and prosper, my friends!
Vitamins and minerals, and trace minerals for that matter, are micronutrients that the human body requires in specific concentrations to function optimally. They are substances which, if we are deficient in any of them, may potentially disrupt normal physiological processes, including bioenergetics. However, when consumed in excess dosages at supraphysiologic levels, micronutrients do not further improve health nor enhance mental or physical performance. In some instances, repeated mega-dosing of certain fat-soluble vitamins such as Vitamin A can in fact be toxic to the human body, and even some water-soluble vitamins such as Vitamin C can put a strain on the kidneys as the body has to metabolize and excrete the excess dosage, with potential consequences such as kidney stones or mild disruptions in the body’s acid/alkaline base that can compromise health.
I have chosen to highlight this topic of dosing in my blog today specifically because, as a nutritionist, I have observed for decades an alarming obsession by a health conscious segment of the public to megadose micronutrients, as though large doses of vitamins were a panacea of health, a trend that has been driven aggressively by the mass marketing strategies of nutraceutical companies selling products that indirectly claim to resolve the etiology of virtually every chronic and acute malady, even aging. Everyone reads the large print on a supplement label, but few people read the fine print, especially the ubiquitous FDA warning: “THESE STATEMENTS HAVE NOT BEEN EVALUATED BY THE FOOD AND DRUG ADMINISTRATION. THIS PRODUCT IS NOT INTENDED TO DIAGNOSE, TREAT, CURE OR PREVENT ANY DISEASE”. Caveat emptor indeed!
That said, the role of vitamins and minerals in bioenergetic processes can hardly be understated. You can top off a car’s gas tank, but if it is low on oil and poorly maintained, it will surely break down sooner or later. Further hampering a proper scientific literature review of the role of vitamins and minerals in bioenergetics are numerous confounding variables and multivariates that are rarely factored into studies looking at micronutrients. One noteworthy problem common to nearly all such studies is the lack of testing of subjects’ baseline levels of vitamins at the start of the study. It presents as extremely difficult to know for certain whether a study participant benefited from the supplementation of a specific vitamin because they were initially deficient in that micronutrient on a cellular level, as determined by tests such as Spectracell’s intracellular functional micronutrient analyses and mitogenic stimulation and measurement of DNA synthesis, as opposed to the overly simplistic measurement of circulating levels of micronutrients in plasma sometimes ordered up by family physicians in a standard blood panel, which is nowhere near as accurate as Spectracell’s testing methods.
An excellent illustration of the abovementioned point may be found in a clinical trial from 2007 which involved a period of supplementation of vitamins C and E that lasted 3 weeks. The subjects from one group consumed a daily dose of 400 mg of vitamin E, subjects from the second group ingested 1000 mg of vitamin C, subjects from the third group ingested 400 mg of vitamin E along with 1000 mg of vitamin C, and subjects from group 4 (the control group) consumed a placebo. Exercise testing was administered in the form of an anaerobic sprint test (RAST) and the Cooper 12-min run test. The results indicated that there were no significant differences between groups during the study in anaerobic power assessed by RAST. The study did however find a significant difference between groups in terms of aerobic power (p < 0.05), indicating an association with aerobic glycolysis and oxygenation of the blood. The study concluded that daily consumption of vitamin E, vitamin C, and a combination of vitamins E and vitamin C for a period of 3 weeks significantly improved aerobic power. However, this is yet another study that did not look at the baseline or post-study intracellular concentrations of micronutrients in study participants, hence making it impossible to determine if the subjects benefited as observed because of pre-existing deficiencies in vitamins E and C or from the ingestion of unnatural supraphysiologic doses of the vitamins, thus placing in doubt the validity of conclusions drawn from the study. As with all matters relating to science, especially in the murky depths of nutrition science, the proverbial “devil is in the details”!
U.S. government guidelines on exercise are clearly heavily influenced by the notion of “exercise” as a ubiquitously nebulous concept in the collective consciousness of the general public. On the plus side of this equation, certainly it is true that any amount of exercise, even a paltry 30 minutes 6-7 days a week is better than no exercise at all. On the negative side, I do not feel that government recommendations go far enough in detailing an actionable definition of what constitutes sufficient frequency, duration and intensity most likely to offer tangible health benefits for the average person. The terms “exercise” or “moderate physical activity”, as defined by ACSM (American College of Sports Medicine) and government semantics, is at best a useless generalization that is open to broad interpretation by individuals, similar to my Number One pet peeve in nutritional nomenclature: “healthy diet“.
Case in point. If a person interprets “30 minutes of moderate physical activity” as sluggishly ambling around on a golf course with a caddy in tow or, even worse, driving in a golf cart around the same course, such physical activity is only marginally superior to laying on a sofa vegging out in front of a television with a beer and bag of potato chips in hand. Studies specifically show that in order to have any significant impact on chronic disease risk factors (e.g. diabetes, obesity, cardiovascular disease, etc.), exercise must raise the heart rate to at least 65-70% of maximum for at least 30 minutes a day a minimum of 5 days/week, a nuance which is tragically missing in FDA guidelines. Certainly, a person walking on a golf course or around their block at 2 mph is at least burning a few calories, but they are not doing much to benefit their cardiovascular system or to reverse Metabolic Syndrome and insulin resistance that is endemic in sedentary individuals and those not availing themselves of aerobic heart rate zones during exercise, as I previously delineated.
Another crucial consideration in all this is a phenomenon that has only recently come to the forefront of discussion in the halls of academia, a condition informally known as ACPS, i.e. “Active Couch Potato Syndrome“, namely the quandary of a person who exercises diligently 30-60 minutes/day (in many cases, intense exercise), yet spends the remaining 23 hours of their day either sitting on their tush in front of a TV or computer screen, behind the wheel of a car stuck in traffic, or laying in bed sleeping 6-8 hours every night (the only truly requisite down time). It has been proposed by researchers that no amount of relatively brief daily exercise, 60 minutes or less at any intensity, can fully overcome the detrimental consequences of ACPS. So don’t think that just because you crushed it in the gym in the morning, that gives you free license to sit around the rest of the day or to eat whatever you want because you’ve “earned it”, but the topic of post-exercise dietary over-indulgences is a huge subject matter on its own, best reserved for a future blog post. In the meantime, just keep moving, keep walking, keep lifting heavy things, play outdoors with your children, go up the stairs instead of taking the elevator, and NEVER EVER battle for the parking spot closest to the front entrance of your gym (I have seen this with my own two eyes)!
The subject of fluoride and dental health are now unfortunately ubiquitously associated with each other in the collective consciousness of the general public, especially as we humans have foolishly abandoned the core principles of our traditional ancestral diets in favor of a modern diet replete with sugar-laden pseudo foods. I’m pretty sure that cavemen never brushed their teeth, yet we can examine their skulls and marvel at the splendid dentition and structural beauty of their teeth and jaws. No dentists needed back then! In the first half of the last century, Weston A. Price, a dentist himself, conducted an epic decades-long investigation of indigenous peoples around the world to uncover how such folks living in abject poverty could sport such magnificent teeth and jaws consuming their traditional diets, people who did not own toothbrushes and had no access to fluoride (see picture at the bottom of this post).
Ironically, the same reports that hint that the alleged benefit from fluorides are due to ingestion are inconsistent with evolutionary biology, i.e. fluoride’s caries-preventive properties were initially attributed to changes in enamel during tooth development because of the link between fluoride and cosmetic changes in enamel and a belief that fluoride incorporated into enamel during tooth development would result in a more acid-resistant mineral. A recent CDC report acknowledges new studies which indicate that the effects are “topical” rather than “systemic.” Laboratory and epidemiological data also suggest that fluoride prevents dental caries predominately after eruption of the tooth into the mouth, reaffirming that its actions are indeed topical for both adults and children.
The obvious question is this: How can the CDC consider the addition of fluoride to public water supplies a public health success while admitting at the same time that fluoride’s benefits are not “systemic”? In other words, no benefits are obtained from drinking fluoride. The emerging truth, now becoming increasingly evident, is that fluoridation and the proclaimed benefit of fluoride as a means of preventing dental decay is perhaps the greatest “scientific” fraud ever perpetrated upon an unsuspecting populace, aside from perhaps the dietary fat/cholesterol heart health hypothesis that has killed millions of Americans since the 1980s.
Even worse, the relentless promotion of fluoride as a “dental benefit” is directly responsible for the neglect by public health authorities in properly assessing its toxicity when ingested by humans over a prolonged period, an issue that has become a major concern for many nations. As there is no substance as biochemically active in the human organism as fluoride, excessive total intake of fluoride compounds might well be contributing to many diseases currently afflicting mankind, particularly those involving thyroid dysfunction. In the United States, most citizens are kept entirely ignorant of any adverse effect that might occur from exposure to fluorides. Dental fluorosis, the first visible sign that fluoride poisoning has occurred, is declared a mere “cosmetic effect” by the dental profession, although the biochemical events which result in dental fluorosis are still unknown. The quantity and frequency of application of topical fluoride that is needed to prevent caries but avoid dental fluorosis is also unknown. Does this mean that we should all stop brushing our teeth with toothpaste containing fluoride, especially if we are consuming a Standard American Diet (SAD)? No. But I certainly wouldn’t drink tap water anywhere in America unless I was dying of thirst! Neither should you.
This is indeed a loaded topic. Before I begin to discuss the science of exercise as a vehicle for “weight loss”, I feel compelled to inject an anecdotally-based observation from my own personal experiences with diet and fat loss, as documented in a bestselling book on evolutionary biology as a foundation for optimizing human health, “The Primal Blueprint” by Mark Sisson, published in 2011. Here is a link to the digital version of my story: http://www.marksdailyapple.com/just-shy-of-50-years-old-and-ive-never-felt-or-looked-better/. Both my anecdotal and professional experiences working with clients and patients as a Personal Trainer and Clinical Nutritionist for 10+ years have highlighted the true biochemistry of fat loss, later confirmed by my college studies. I have repeatedly explained to my clients that “you cannot exercise your way out of a bad diet” and that “80% of weight loss is to be found in the kitchen, not the gym. Granted, you have to have both components in place to achieve meaningful sustained fat loss, and by this I mean loss of body fat, not “weight loss” per say, which could consist from one day to the next of anything from water weight, depletion of intramuscular glycogen stores, or even muscle wasting caused by extreme caloric deficits. When the number on the scale nudges downward, it is not automatically a cause for celebration because one cannot know for certain how much of that weight decrement is actual loss of body fat. That said, the impact of exercise on decreasing the size of adipocytes (fat cells) is beyond doubt, but I see this mechanistically as more of a hormonal equation than a caloric one. You can be in a caloric deficit just be eating less and exercising more, but if the macronutrient composition and glycemic load of a diet does not induce lowered insulin and elevated glucagon levels that act upon HSL (hormone sensitive lipase) to cleave triglycerides from adipocytes, the opportunity for lean mass catabolism substituting for a healthy reduction of fat mass is always a danger. Fat loss is a thorny proposition indeed!
It would behoove us to factor in that the majority of body fat that is burned during even an optimally effective exercise session is in fact derived predominantly from intramuscular fat stores (the marbling we see in a fatty cut of steak), not circulating plasma FFA (Free Fatty Acids) from intra-abdominal or subcutaneous fat stores, i.e. the fat on our bodies that is visible to the naked eye when we walk on a beach in our bathing suits. Visceral or intra-abdominal fat in particular (the fat around our internal organs, such as our liver) is known to contribute to pathological insulin resistance manifesting as Type II diabetes and the various permutations of a condition known as Metabolic Syndrome, i.e. elevated blood sugar and blood pressure, increased triglycerides and heart disease risk. An individual who is dieting and exercising to lose weight could get a DEXA (Dual-energy X-ray Absorptiometry) scan done a few weeks after commencing an exercise-based weight loss regimen and they would find that the vast majority of reduction in their body fat stores was in fact attributable to the aforementioned intramuscular fat, not subcutaneous fat, following extensive bouts of aerobic exercise, or even resistance training for that matter, which can certainly elicit frustration in diligent dieters because the change that they see in the mirror is skinnier looking arms and legs due to loss of intramuscular fat while still carrying a significant amount of fat around their abdomen and/or hips (the “pear-shaped” hypothesis), as well as retaining substantial visceral fat stores, e.g. NAFLD (Non-Alcoholic Fatty Liver Disease), which is further exacerbated by standard low-fat high-glycemic weight loss diets. This is primarily why I am irritated by the meaningless term “weight loss”. Weight loss consisting of what? Apparently, many people do not care what their weight loss is comprised of, just as long as the scale shows a lower number than the day before. On the other hand, physically active people who have dialed in their hormonal health, stress reduction, sleep hygiene, and consume a diet that consists of a high proportion of healthy fats, adequate protein intake, and very low consumption of refined sugars tend to burn more subcutaneous fat while they are asleep, yes, I said asleep, and they wake up in the morning with slightly lower subcutaneous fat than when they went to bed the night before. Shocking but true!
It is even possible for someone, such as a hard-charging athlete, to lose 5 pounds of subcutaneous and intra-abdominal fat while gaining 5 pounds of muscle, hence they achieve no “weight loss” on the scale, yet look and feel better and have improved health outcomes. As with all aspects of human physiology, the proverbial “devil is in the details”. So make sure to be extremely wary of anything that identifies itself as a “weight loss” program. Oversimplifications are just pure marketing hype directed at emptying the pockets of unsuspecting consumers. Don’t go to the gym to “lose weight”. Go there to get stronger and fitter, to improve your flexibility and functional strength, to increase your bone density, to repair your hormones and improve your mood, and you should be skeptical of any Personal Trainer who tells you that they will help you “lose weight” or any book with a tagline such as “Lose 30 pounds in 30 days”. If you want to lose actual body fat, and do so safely, go home and clean out your pantry and refrigerator. Get rid of anything containing added sugar, anything that promotes inflammation in the body (such as vegetable oils and margarine), anything that spikes your blood sugar and leaves you feeling drained two hours later. Then you will finally start to fit into your skinny jeans and recapture your health and vitality, as I myself did 8 years ago, when I switched careers from obese software engineer to health coach and nutritionist.
The physique of the amazing young woman in the picture below is 50% genetics, 40% nutrition, and 10% exercise, but that 10% is just as important as the other 90% of the equation, because when it comes to looking and feeling your best, anything less than 100% amounts to 0%. We cannot choose our parents (genes), but we can choose what we put into our mouths and how we live our lives!
Studies have shown that Seventh-day Adventists in Loma Linda, California, from diverse genetic haplogroups, tend to live as much as a decade longer than the rest of us, which led to Loma Linda’s inclusion by author Dan Buettner as one of the five global longevity hot spots, which he calls “Blue Zones”, the only one in the United States. It is indeed noteworthy and somewhat surprising that there exists but one “Blue Zone” in a country of over 350 million people. One would think, with our economic prosperity and advanced healthcare technologies relative to most of the world, that we would have several other Blue Zones in our midst, yet we do not as of this writing. It may therefore behoove us to make an effort to identify the specific dietary and behavioral characteristics of Seventh Day Adventists that appear to contribute as ubiquitous influences on their extraordinary vitality and longevity.
The following features emerge as most pertinent:
- Low-meat diets, which we can take one-step further by proposing that what Adventists are really minimizing is not just meat per say, but rather the consumption of highly processed meats obtained from CAFO (Concentrated Animal Feeding Operations), i.e. animals pumped full of hormones/antibiotics and fed grains that are unnatural and harmful to them.
- Weekly fasting as a religious practice, which happens to facilitate autophagy, the metabolic process through which damaged or senescent cells are destroyed in vacuoles within the cells, preventing them from mutating into dangerous senescent cells that accelerate the aging process or, worse yet, the proliferation of cancer cells.
- Adventists tend to socialize only with other likeminded Adventists, thus less likely to engage in risky health behaviors because of their religion and more likely to be cared for by immediate family and a tight knit community as they grow older.
- Regular low-level aerobic exercise such as walking and bicycling, seniors exercising in groups, enjoying physically active hobbies such as gardening and home improvement projects.
- Frequent social events with peers, usually faith-based community events. In Buettner’s study of the Blue Zones, it was found that religious denomination did not seem to matter. Research shows that attending faith-based services four times per month adds 4-14 years of life expectancy, independent of other factors. Social interactions with others, in person (not social media), is essential to our emotional well being and survival. Humans are pack animals by nature!
- No alcohol, no drugs, no smoking, no junk food. Any questions?
As stated repeatedly in this and other of my blog posts, a recurring theme which is surely worth repeating is that the true “secret” to longevity is mostly exclusionary in nature, a feature common to all the Blue Zones regions, including Loma Linda, i.e. their success is achieved primarily through the diligent elimination of harmful toxins and negative influences on their exposome. The exposome can be defined as the measure of all the dietary, chemical, and environmental exposures of an individual in their lifetime and how those exposures relate to health and longevity. It is noteworthy that 100 years ago, before the mass adoption of the deadly Standard American Diet (SAD), most Americans lived and ate much like Seventh Day Adventists do today, simply because modern processed foods and CAFOs did not exist back then. “Free range eggs” were just called “eggs” and “grass fed beef” was called “beef”. Want to live a long healthy life? Just roll the clock back to 1918 in your kitchen and be physically active throughout the day. Nobody sat on their butt all day in front of a computer in 1918!
Social media as a potential platform for health education/promotion is an intriguing topic, one that is ripe with controversial permutations in the halls of academia. I think that this may serve as an excellent example of a context in which graduates who obtained their degree in health education any more than two decades ago may be at a slight disadvantage in terms of utilizing social media as a tool in health promotion campaigns. At 56 years of age, I can personally recall a time when the only community health education available were pamphlets in the waiting room of doctor’s offices or at the local YMCA or community center, or sometimes in the form of “junk mail” from local hospital networks (I still get those in my mailbox).
I’ve decided to adopt a slightly less formal tone for this discussion, given the nature of the subject matter. Facebook, Twitter, and other forms of social media have in recent years de-evolved in many ways, reminiscent of the National Enquirer or The Globe in print media. When I log into Facebook these days, the sheer amount of rubbish posts on health and fitness propagated by seemingly reputable commercial entities is overwhelming! Most of the “health promotion” and “heath education” links are just advertisements for ridiculous “snake oil” products without any true science behind them. In this disturbing era of legitimate science sometimes labelled as “fake news”, the problem is that even when a respected institution of learning or legitimate health provider posts information on social media for mass dissemination, the data are often distrusted by the recipient. Yet, despite the inherent challenges of social media used for health promotion, health educators clearly cannot afford to ignore a form of public communication whose tentacles extend as far and wide as social media platforms. As with any tool created by humans, social media can either be misused as a weapon for spreading ignorance and misinformation or it can be used as a force for positive change.
Board-certified health educators would benefit greatly from formal training in the use of strategies for social networking to promote public health. Here are a few ideas that I came up with:
- Every medical center and care facility should have a Facebook site that posts daily information on health issues.
- Medical facilities should encourage their patients, especially a younger demographic, to “follow” them on Facebook or Twitter.
- Facebook and Twitter should have a symbol or alert feature which notifies users that the source of a post or tweet can be traced back to a legitimate trustworthy authority that has been verified by a government agency such as the FDA or NIH, as opposed to some shady supplement company trying to sell its ‘snake oil juice’ to unsuspecting consumers.
- Advertising and promotion of health-related products on Facebookand Twitter should be regulated by the FDA with disclaimers as applicable, same as any bottle of vitamins with the familiar FDA warning on the label.
- Schools and universities should take the initiative to launch massive health education/promotion campaigns utilizing Facebook and/or Twitter that updates users on the most current findings in research and dispenses diet and lifestyle recommendations accordingly. Such initiatives should emphasize to consumers that information disseminated on health-related topics should only be given credence if they originate from trusted academic sources.
- The general public need to be educated on the use of alternative search engines, instead of relying solely to Google, which has become a virtual wasteland of misinformation and advertising. Examples of reliable sources for nutrition and health-related news and the latest scientific studies include:
- Misinformation deliberately or inadvertently spread by any form of mass media, e.g. television and the Internet, such as the ridiculous ‘news story’ from a couple years back that misinterpreted and sensationalized a particular study which concluded that people should stop taking multivitamin/mineral supplements because they are “worthless” should have been immediately discredited on social media by the FDA or AMA or any respected institution of higher learning.
- Health-related government entities (e.g. CDC, PubMed, FDA, USDA) should all have a strong presence on social media platforms in this day and age, but they do not currently. Our tax dollars hard at work, right?
In conclusion, social media presents as a mostly untapped resource for health educators and promoters, not only because it reaches a much larger audience than most web sites or printed literature, but also because it caters to a largely uninformed population that tends to be afflicted with what I like to call a “smartphone attention span” and who are inundated daily by confusing and often conflicting data. In a political climate in which science is scorned and distrusted, in a time of ‘flat earthers’ and ‘climate change deniers’, is it any wonder that it has become so challenging to get out reliable information to the public on health-related matters?
Let’s talk about neurotransmitters. Specifically, dopamine and serotonin, the “reward” and “feel good” chemicals in the brain that are inextricably intertwined with our perception of appetite. Appetite is about so much more than just hunger or our need to fuel our bodies. Appetite is emotional regulation, stimulated by powerful emotions and our baseline psychological state. Appetite is also a product of social intercourse. Stress initiates the release of cortisol, which also stimulates appetite, and so we quickly reach for a sugary snack like a donut to calm our nerves and sedate us, sometimes fragmenting into common eating disorders such as bulimia and anorexia nervosa.
During my employment as a Clinical Nutritionist at a medical weight loss clinic for just over a year, I quickly learned that most folks whom I was counseling did not primarily struggle with hormonal or metabolic derangement, they suffered from psychiatric disorders connected with food. They did not really need my help to tell them what to eat. They already knew that the foods they were eating were bad for them. Their appetite was driven by depression and anxiety, not hunger or a caloric energy deficit. Most of them were also obese, which is etiologically driven by the underlying comorbidities of Metabolic Syndrome, further exacerbated by insulin and leptin resistance resulting in dysregulation of grehlin and leptin signaling. These individuals facing psychosocial obstacles to healthy eating required interventional treatment by a qualified psychiatric professional in close collaboration with myself and the Functional Medicine physician who was my employer at the time.
Personally, whenever I feel hungry, aka a “healthy appetite”, the first question I always ask myself is simply: “Am I truly hungry or just bored and depressed?” Or maybe I’m just confusing hunger with thirst (another often overlooked factor). “Appetite” is a loaded word. Take for example the French tradition of the aperitif, which I clinically define as choosing to become slightly inebriated and spike one’s blood glucose in an effort to artificially stimulate appetite prior to a meal. I’m pretty sure that our hunter-gatherer ancestors did not enjoy the luxury of consuming an aperitif before they went on a hunt for bison. We can ramble on and on about advanced concepts of nutrition and metabolism as science, but the reality is that there is much more to appetite than biochemistry! When we reach for a bag of potato chips or a tub of ice cream, we are motivated by our reptilian brain, not our higher brain functions that know full well how bad those substances are for us. It’s about “comfort foods” and instant gratification, gluttony and sloth, a salve on our emotional wounds. I therefore unashamedly propose a politically incorrect hypothesis, i.e. that most obese unhealthy people don’t need a nutritionist. What they really need is a good psychiatrist! I wonder if it’s too late for me to get a dual Masters in Nutrition and Psychology?
The importance of empirical evidence-based interventions for community health promotion cannot be overstated. Analysis and reporting of data are critical for the development of effective programs because they need to be founded on real-world needs within a specific community or population. As always, I emphasize the point that communities are comprised of individual members of the community taken as a whole, an excellent starting point but hardly a “destination” in effective health interventions. Public health programs, including those involving financial incentives, would likely be more effective if designed based not on how perfectly rational people ought to make health decisions but on how real people actually make them. Clearly, any potentially efficacious health promotion program based on an assessment of community needs and program evaluations must be grounded on pragmatism to be truly successful. Academic constructs such as ‘Expected Utility Theory’, ‘Prospect Theory’, and ‘Nonlinear Probability Weighting’, all reflect to varying degrees individuals’ response to health promotion efforts within specific communities, most often via traditional asymmetric paternalistic approaches to public health policy on a micro and macro level. Perhaps the most erroneous of these constructs is ‘Expected Utility Maximization’, i.e. the presumption that humans are always rational and driven primarily by “self-interest”, which is not only an unrealistic expectation but also a double-edged sword. I would propose a not unusual scenario in which an individual’s personal definition of “self-interest” is to be extremely inebriated as often as possible while still holding down a job they hate and continuing to endure a loveless marriage for practical reasons, whereas another individual’s definition of “self-interest” might involve staying as fit and healthy as possible while maximizing their longevity. We all have to have priorities, right?
So, what we have essentially is two or more target audiences for any grandiose health promotion campaign within a community. How then do we judiciously apply needs assessments and program evaluations to a community composed of both similar and dissimilar individuals? Do we just shrug and commit the sin of generalization, patting ourselves on our shoulders for our well-meaning intentions and meddling interventions? Further complicating health promotion efforts is the hot topic of ‘Nonlinear Probability Weighting’, which strongly influences individual health choices, such as when reference dependence leads to getting drunk at a bar with co-workers every evening after work, a behavioral component not likely to be altered by health promotion programs warning of the dangers of excessive alcohol consumption. It’s great to have some sort of well-designed health education program in place as a starting point for broad interventions but, in the final analysis, what people really need is not health education (they know full well what they’re doing to their bodies) but rather realistic motivations for change, based on the same emotional impulses that lead them to pursue an unhealthful lifestyle habit, since we already know that rational thinking is not what drives most unhealthful behaviors. The precipitating impulse for an unhealthful behavior is usually just a selfish desire for immediate pleasure and satisfaction, further framed within the context of camaraderie and social norms, a desire to be loved and accepted, to simply “fit in”, none of which have anything to do with healthful practices, unless of course one makes the superhuman effort to change one’s environment and circle of friends.
Health education and health promotion are indeed complex, intellectually challenging propositions, further hampered by budgetary and legislative limitations, especially when it comes to government-sponsored programs. I have nothing but the highest admiration and respect for anyone who chooses this difficult line of work as their vocation!
On the con side of the industrialization/globalization of the food supply equation, it presents as particularly noteworthy that the hard sell attitude of the fast-food industry is self-evident all over the world. For example, as we are now deeply immersed in the 2018 Winter Olympics, MacDonald’s and Coca-Cola are two of the nine major sponsors for the Games in PyeongChang, which is a rather odd oxymoron. MacDonald’s accounts for less than 2% of the total revenue for the Olympics, but still splashed out $200 million for the four-year period leading up to the Olympics. They have been major partners with the IOC (International Olympic Committee) for the last 40 years. Prior to the 2016 Olympiad, McDonald’s built a 1,500 seat restaurant on the Rio Olympic site, the biggest in the world, and stated that they are trying to “raise brand awareness”, as did Coca-Cola. I just wonder who those people are, sitting in the stands watching the Olympics, that are unaware of the existence of MacDonald’s and Coca-Cola, absorbing the stagnant branding of these monolithic processed food corporations. My point is that aggressive advertising is deconstructing food cultures that outdate us by millennia and have been a huge part of the formation of national identities around the world. This for me is extremely disheartening. When travelling these days, in certain areas, I have noticed that it has become nearly impossible to find and immerse myself in the flavors of a nation, a sad fact that is becoming more and more apparent with each passing year. One must also keep in mind that just by calling your restaurant “Burgermeister”, your burgers do not suddenly become part of local German cuisine, even if the burger tastes wonderful!
On the pro side of the industrialization and globalization equation, in our carbon emissions-obsessed era, local food activists (“locavores”) have embraced the notion of “food miles,” i.e. the distance that food items travel from farms to consumers, as the be all and end all of the environmental impact of agricultural production. As has been repeatedly and rigorously documented in numerous life cycle assessment (LCA) studies, however, the distance traveled by food is pretty much a worthless indicator of sustainable development. Among other issues, producing food typically requires much more energy than moving it around, especially when significant amounts of heating and/or cold-protection technologies, irrigation water, fertilizers, pesticides, and other methodologies are required to grow crops in one region, but not in another. Reducing food miles typically means a greater environmental footprint, given the use of additional resources in less desirable locations. Another issue is that the distance travelled by food matters less than the mode of transportation utilized. For instance, shipping food halfway around the world on a container ship often has a smaller footprint per item carried than a short trip by car to a grocery store to buy a small quantity of these items. Very few issues are as straightforward as they might seem at first glance!