In medical school our only nutrition class was mostly about all the horrible things that
can happen to you with severe vitamin and protein malnutrition, like scurvy the 4 D’s of niacin deprivation: dermatitis, dementia, diarrhea and death. That’s the kind of thing we had pop quizzes on. If you didn’t have beriberi or kwashiorkor, you must be healthy. They never put any emphasis on fruits and vegetables as part of a healthy lifestyle.

Nothing was discussed in terms of transitioning a patient’s diet to something more healthful, which happens to be what you need the most when you’re a practicing MD. Nothing. Nada. Not a word!

Some time ago Dr. Dean Ornish developed a heart disease program for patients that were told they needed bypass surgery. It included a vegetarian high-fiber, low-fat diet. He ran it head to head against cardiac bypass surgery. His program was equal in efficacy to the surgery, and it cost less, so the insurance company, Mutual of Omaha, started covering it in their policies. Unfortunately, none of the other major insurance companies followed suit. I believe that to be due to economics more than anything else. Even though it would cost the general public and even the insurance companies less for the Ornish program than it would for the bypass surgeries, there are more cardiologists and cardiovascular surgeons than there are nutritionally-minded preventative doctors. It’s not a conspiracy or anything, it’s just that professionals believe in what they know how to do. In this country, the squeaky and organized wheel gets the grease, and it will take a long time before there are as many voices on the Ornish side as there are traditional interventional cardiologists and cardiothoracic surgeons. There’s also our tendency to want passive, quick fix solutions to our health problems. Open-heart bypass surgery or angioplasty takes under a day to do, plus under a week in the hospital, and then a few brief follow-up visits. The Ornish diet is forever, and takes a lot of coaching and support.

It’s hard to figure out how nutrition can cause or help the diseases we’re getting. Most studies gather data by asking people to report what they have eaten in the past, and most folks see their dietary habits through very rosy glasses, if they pay attention at all, so self-reported dietary intake is pretty unreliable, which may be why so many recent epidemiological studies of nutrients have such counter-intuitive results. Diet is so complex an issue. Right now, if a person feels better on a vegan diet and worse eating dairy and meat, that is about as reliable as a big NIH study.

But there has been change. The FNB’s recommendations concerning dietary health have evolved so that now fruits and vegetables are at the base of the food triangle. Next are the starchy foods, mainly consisting of corn, potatoes, beans and whole grains. After that come your protein foods; which include not just meat, but beans and legumes, and even certain combinations of grains. At the very top come fats, oils and sweets. So a good question is, if we don’t need much fats and sweets, why do we eat them so voraciously?

The three scarcest foods in nature are salt, sugars, and oils. In our evolutionary past, to get oils one had to go out and kill something or go through a very laborious process to extract oil from avocados, olives or nuts. Salt is another resource that historically was not abundant. People had to go to an ocean to extract salt from water, or barter for it if they didn’t have an ocean. Sugar was also hard to come by, as the only sweets available were fruits and berries that you had to pick from trees, vines and bushes in small portions. All of the native forms of the fruits that we eat were much, much, smaller back then. You had to gather a lot more of them to get the same quantity as today’s version. So those three most limited foods required the most motivation to gather. This may explain our pre-programmed cravings for fats, sugars and salt.

Then comes the profit motive: fat, sweet, and salty sells. I heard one medical school lecturer put things into perspective during our small amount of nutritional instruction. He said that if you froze someone in 1940 and then woke her up again in 1980 and gave her an Oreo cookie, she would probably gag on it and spit it out! He explained that this is because over the years the amount of fats and sugars in Oreo cookies has just gone up and up and up, and people have bought more and more and more. If you’re a food company with shareholders and overpaid executives, the profit motive is hard to fight with mere nutritional theory.

Unfortunately, America’s most problematic chronic health conditions are all things that are more prominent in industrialized countries where the diet is rich in fats, sugars and salt. Limiting these is the main nutritional strategy to prevent chronic disease, and that applies to a vegan diet as well as a Standard American Diet (SAD).

By the way, in a vegan diet the best way to get essential fatty oils is by eating a handful of raw nuts or seeds. You may have noticed that raw nuts don’t get rancid, because of their anti-oxidants and natural preservative compounds. Peanut butter and even roasted peanuts have the possibility of going bad (because they are not nuts but actually legumes). But I’ve had raw cashews around for a long time, and they don’t get rancid! It seems that the best way to get the essential fatty oils is the way we were getting them when we were hunter-gatherers, just working hard to get a little of those precious oils.

Food Guide Pyramid published by the FNB.
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