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Shantanu Nundy, MD  
Male
Chicago, IL

Specialties: Preventive Health, general medicine

The University of Chicago Primary Care Group
Department of Internal Medicine
773-702-0240
Chicago, IL
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A Food-Based Approach to Eating

Feb 22, 2011 - 8 comments
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Nutrition

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Healthy Eating

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carbohydrates

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saturated fat

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Protein

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food

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Diet

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Fruit

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Vegetables

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Vitamins

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Minerals

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food science

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dietary guidelines

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dietary guidelines americans



The science of nutrition is changing and not in the way you might expect. After years of “reductionist” thinking — where food has been viewed as the sum of its parts – a call to treat food as food has been sounded. No more poring over nutrition labels to calculate grams of fat or chasing down the latest go-to chemical – be it vitamin E, fish oil or omega-3. Instead we are being asked to call a potato a potato and a piece of steak… well… a piece of steak.

If you haven’t heard about this sea change yet, you are not alone. The food science industry that markets “food products” for our consumption has done a good job giving their laboratory creations a semblance of health with phrases like “low fat” and “high in vitamin C”. For our part, the medical community is also to blame. Despite evidence to the contrary, we have been slow to renounce the “fat is bad” mantra or break away from the nutrient-based approach to eating that first swept the country over 30 years ago.

Until very recently, the dissenting opinion was expressed mainly by food journalists and self-proclaimed naturalists. In the book "Good Calories, Bad Calories," Gary Taubes argues persuasively that the science behind vilifying fats is fatally flawed and proposes that carbohydrates, and in particular sugar and high fructose corn syrup, are the real bad guys. Michael Pollan, perhaps the best quoted food journalist-turned-activist, goes further to suggest the whole notion of understanding food by its constituent parts – fat, protein and carbohydrates or even saturated fats, unsaturated fats, and trans fats – is plain wrong. He opens "In Defense of Food" with three dictums for healthful eating: “Eat food. Not too much. Mostly plants.”

Now the scientific and medical literature is coming around. A review in the Archives of Internal Medicine of over 500 trials found “insufficient evidence” that the intake of dietary fat (except for trans fat) is associated with coronary heart disease.(1) More recently, an editorial published in the Journal of the American Medical Association (JAMA) August 2010 entitled “Dietary Guidelines in the 21st Century – a Time for Food” writes “little of the information found on food labels’ ‘nutrition facts’ panels provides useful guidance for selecting healthier foods to prevent chronic disease.”(2)

Don’t let the plain academic language lull you – what these scientists have published in arguably the world’s most prestigious medical journal is that the entire approach to food based on nutrients is wrong.

It’s not that eating the right nutrients is hard (how are you supposed to know if less than 30% of your calories comes from saturated fats?) and that the science of nutrient-based eating is bad (this is too academic to get worked up about), it’s that our focus on nutrients has actually made our food MORE unhealthy. In an effort to engineer “better” foods, we created trans fats, which we now know are deleterious to health, and food products that are low in fat but high in dough conditioners (whatever that is). Indeed, as saturated fat consumption has decreased, our collective burden of chronic disease and obesity has only increased.

So if fat is not bad, and we shouldn’t be thinking about food in terms of individual nutrients, what are we left with? Surprisingly, we are pretty much where we were in our grandparents’ generation, a time before we thought we could improve health by manipulating individual nutrients, and when food was just food. As the JAMA article concludes “… although this approach may seem radical, it actually represents a return to more tradition, time-tested ways of eating.”

In fact, the most convincing studies of dietary patterns that prevent or retard chronic disease are food-based. Fruits, vegetables, whole grains, and nuts have been consistently associated with lower risk of disease while fish consumption has lowered the risk of death from heart disease. And these effects are above and beyond what you see from diets with equal levels of protein, fat, and carbohydrates.*

A food-based approach to eating is not only healthier but also easier. Instead of worrying about things you can’t see, smell or taste; it asks you to pay attention to what you are putting in your mouth. It supports an eating plan of fruits and vegetables, whole grains, and unfettered meats over processed foods, packaged meats, and sugar-laden beverages; and favors home-cooked food over store-brought or restaurant meals.

So the next time the hunger pangs strike, check your energy bar at the door and drive on by the local diner. Instead go to your local grocery store, buy yourself some fresh food, and prepare yourself a hearty, wholesome and healthy meal.


- Shantanu Nundy, M.D.


*It’s not hard to imagine why. Fish has way more in it than protein, different types of fat, and carbohydrates; and even if we could categorize every vitamin and micronutrient in fish we wouldn’t yet understand how these nutrients work synergistically to impact health.

1 Mente A, de Koning L, Shannon HS, Anand SS. A systematic review of the evidence supporting a causal link between dietary factors and coronary heart disease. Arch Intern Med. 2009 Apr 13;169(7):659-69.

2 Mozaffarian D, Ludwig DS. Dietary guidelines in the 21st century–a time for food. JAMA. 2010 Aug 11;304(6):681-2.

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by aelgar, Feb 23, 2011
Thank you. Finally. I've been saying this to my family for a while now. Stop trying to make food more complicated than it is - portion control and mostly plants! Now if we could just get rid of pesticides in our plants...

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by macwabana, Feb 23, 2011
Bravo!  Finally an M.D. joining my alternative medicine practitioners in giving wise preventative medicine advice.

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by Smokenugs, Feb 23, 2011
Though I don't pass up the opportunity to have pizza and beer, I've been eating around 50 to 64 oz. of vegetable and fruit smoothies spanned out over 3 meals a day for years now, ever since I began to explore and understand chemical sciences. It seems that, from an engineering perspective in treating your body like a system, this is all common sense and it relieves me to hear an M.D. begin to speak up about it.

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by Smokenugs, Feb 23, 2011
Just remember, body is made to eat natural foods and absolutely NOTHING comes naturally in a box or can.

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by Gloworm507, Feb 25, 2011
If you must eat can or jar fruit get grape juice sweetened rather than syrup. Eating fruit and veg with chemicals absorbed into every cell. Strawberries and other soft fruits can absorb 27 chemicals (some used in petrol) The food industry refuses to fully support organic growers along with their promotion of prepared vegetarian food with additives,sugar and flour in everything, organic products with palm oil (saturated fat as well as massive deforestation) Organic and gluten free food has high fat and sugar content. My uk local supermarkets cater for the large indian population but stoke them all up with masses of sugar creating a high rate of diabetis. If products say no sugar they have maltose, dextrose with E numbers and Aspatarmi included. So whose responsibility is it to look after YOUR body-nobody else except you. It is up to the individual to read, learn and think before they put food into their bodies. Putting food into the only body you will have is a subject to study well like you learn an academic subject. Why isn't it taught as a subject in schools in te western world? It seems that people in poor countries have more knowledge about simple food that are good for body survival than the western world.  There is too much choice. A car owner wouldn't put sugar in their petrol tank without thinking first that it would stop the car from working.. The food companies don't care as its all about money.
Think before eating not eat before thinking. Sorry folks but it just makes me crazy to see what rubbish some people eat then when they have digestive problems or more they take medication without any thought as to what THEY do to create that illness. I'm not perfect but I try to do the best I can as I know nobody else will do it for me. Good luck!

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by stella5349, Mar 01, 2011
Bravo!!!

very enlightening that more professionals are using their head and writing openly about it...

Keep up the wonderful work putting this out there for the people to read.

Good Luck and God Bless you!

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by margypops, Mar 01, 2011
Great post thank you , maybe as prices start to climb we will be using more home grown food , we will also then be in control of the pesticides used .

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by MrJoe62, Mar 03, 2011
Good information.  It's a reasonable approach to eating.  For people serious about improving their nutrition, you quickly become confused by reading all the different opinions and approaches available, much of which is simply marketing products for profits.  Important issues that I believe need to be considered along with what was discussed, is that much of our produced is grown in depleted soils and have toxic chemicals added to increase production and visual appeal.  Although I've not made an in depth study of it, it seems that meat producers are also using numerous chemicals, hormones, etc. that are not good for human consumption.  In other word, if we could  all produce our own food in a natural, organic way we could greatly benefit.  Obviously, that isn't practical, so we are faced with a major challenge of how we can best feed our bodies and avoid disease
Perhaps as an example of the point of the article, my grandmother lived to be 101 years of age...died in 1983.  My wife and I often commented that her diet was not what we considered a healthy diet and I'm sure she gave no attention to selection based on labels.
Personally, I am now 76 and seldom sick...not taking any medications.  My diet is not  always helpful but I've found ways to improve my nutrition without getting to complicated about it.
Thanks for posting the article.

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