Processing and Whole Food Diets - Internal Debates

I've mentioned before that I'm currently in the process of obtaining both my PhD and the Registered Dietitian (RD) credential. In my opinion, both are very complementary degrees that can inform/influence each other in a positive way, to make one both a better scientist and a clinician. However, at times, they clash - scientific idealism doesn't always align with clinical realism, and vice versa.

My current internal monologue/debate really heated up these past couple weeks, with the release of these two seemingly contradictory articles:
1. For the first report, see here. Dr Yoni Freedhoff, whose blog is a really great read, pointed out a number of somewhat troubling tweets from RD's at the F3K conference. The RD's took to the usual mantra of needing to work with the food industry, and tried to absolve the sins of processed foods. To quote one RD's twitter, "Healthy eating requires - balance of foods, right portions, & proper prep. Don't worry about "processed" focus on right choices"
2. For the second, see here. Marion Nestle followed up on Brazil's announcement of a Food Based Dietary Guideline, which has been receiving a lot of praise from the foodie movement. Dr. Freedhoff's blog, again, has good coverage from one of the post-docs who worked on the creation of these guidelines, which recommend eating mostly home prepared foods, limiting added oils/sugars, and eating with others.

Why are these opposing? These tend to be two pretty polarized perspectives. These RDs, supporting the food industry, take a very nutrient focused approach, and see that food processing can be used to benefit the nutritional profile of foods. Alternatively, the new Brazilian Dietary Guidelines assume that whole foods are inherently more nutritious/stave off chronic disease, and take a large stance against consuming processed/pre-packaged foods. 

The scientist in me sees the movement against processed foods as a bit of a naturalistic fallacy - assuming that all foods that we currently consume are in their healthiest, most nutrient dense form is a bit of a fairytale. Every food that's out there isn't made for humans - nutrient acquisition has largely been a back and forth war throughout evolutionary history between predator and prey. There are several food components that we may not necessarily want, as reflected by a long history of domestication of wild plant varieties. Processing can remove some of the phytic acid from grains/legumes, which limit iron absorption from foods and lower protein digestibility. Food processing can be used to degrade the gluten in bread so that wheat products are no longer a problem for individuals with Celiac's. Fortifying foods with folic acid has been quite successful in reducing the incidence of neural tube defects. Many of the dietary food components that often get a lot of hype don't actually exist in concentrations high enough in foods to be health promoting - benefits like those seen from resveratrol, a popularly cited reason that red wine is healthy, can only be seen from supplementation, due to the bioavailability/half-life of resveratrol from wine being so low. There are a huge number of ways food processing can be used to enhance the nutritional profile of foods - for a nice review on its benefits, see here. The body really only needs nutrients, from a purely scientific perspective. Food processing can provide these nutrients in a convenient manner, while enhancing the physical/sensory characteristics of food products, to meet consumer demand.

The clinician in me was getting anxious while writing the paragraph above, for a number of reasons.

• Sure, we want to avoid naturalistic fallacies, and some improvements to foods, via food processing, can be made. However, that doesn't change the fact that foods, largely, haven't been 'processed' for the better. 
• Processed foods are notoriously high in salt, low in potassium, higher in refined starches/simple sugars/added oils/trans fats, low in fiber and remain a relatively high calorie for a low nutrient punch. Food processors then take those foods and toss in a multivitamin supplement and call it complete. Focusing on just individual nutrients allows for this; focusing on the entirety of the food product doesn't. I've been pretty critical of the isolated nutrient approach in the past, not only for it's role in contributing to chronic disease but also in it's failure to contribute to our understand of nutrient interactions.
• The RD's tweet above to not worry about processed and make the 'right choice' sounds so uppity to me I can't even fathom her lack of relativity - it's so easy for Dietitians, who are trained nutrition professionals, to see healthy choices as being easy to spot, but Food Marketing does a damn good job of making sure that relatively health illiterate consumers see their products as being health promoting. 
• We don't fully understand the food matrix - sure, there are vitamins and minerals, but much research has started to look at phytonutrients, antioxidants, zoonutrients, etc. Companies have begun to add antioxidants and plant extracts to products, including multivitamins, to boast claims about these potentially health promoting contents. The moment science fully understands the food matrix, I'll be okay with this - however, nutrient interactions are far from being entirely understood. Synergy exists between food components i.e. two components of Brussel sprouts, crambene and indole-3-carbinol, synergistically increase an anti cancer marker (quinone reductase) in rodents, soy phytoestrogens (dadzein, genistein, equol) synergistically inhibit LDL oxidation alongside vitamin C, the antioxidant effects of circumin are most potent in the presence of piperine, piperine enhances resveratrol bioavailability. The list could go on and on and we're only at the tip of the iceberg of understanding nutrient synergism, and interactions within the food matrix.
• Too much of this fortification may actually be a bad thing - high beta carotene intake has been a concern for specific types of cancer. The most recent Cochrane review does not find any support for antioxidant supplementation throughout the lifecycle or in disease states, and reiterates concern over high beta carotene supplementation, as well as vitamin E. 
• Until we understand the food matrix, until we understand how to best process foods, whole food-based diets appear to be best for promoting health/wellness, while consuming processed foods in moderation, and to fill nutrient gaps (i.e. calcium fortified almond milk in the event of a dairy allergy/intolerance). 
• However, I don't know of any industry economist that's pushing moderate consumption of their products... Science + capitalism surely isn't my favorite love story.

Overall, I absolutely think food's nutritional value could certainly be improved by food processing. However, this is currently not the case - the moment industry starts to become as concerned with the health of their consumers, as much as they are with their own bottom line, I'll jump onto the processed train. In the long run, I am pro-processed foods, but that doesn't change the fact that in the present, food processing has not focused on health promotion. The scientist in me has hope that food processing will enhance the health promoting aspects of the food system, through responsible fortification, genetic modification, and removal of undesirable dietary components; the clinician in me is realistic in that research is far from understanding how to best process foods for better health, and for now, whole food diets are the most health promoting, though I am willing to change that opinion the moment research suggests otherwise.

This war between pro-processed and pro-unprocessed seems, to me, an overly polarized issue. The pro-processed side needs to call for responsible use of processing, that promotes satiety, nutrient density, and longevity, while offering convenience, taste and overall consumer appeal. The pro-unprocessed side needs to stop assuming that anything that is processed is automatically unhealthy, and that whole foods are inherently superior because "that's how nature intended."They really need to start hating the irresponsibly produced end products, not the process, lest you lose your credibility with the entire scientific community (see GMOs).

As far as Brazil's New Dietary Guidelines are concerned, it's my hope that, in implementing these, they also provides adequate access to healthcare, with regular visits to a nutrition professional/dietitian, who can augment the diet and screen for deficiencies. Just eating whole foods doesn't automatically mean one will be healthier, and proper nutrition/supplement education will be necessary to ensure that this approach is successful.

For a good read on setting up Food-Based Recommendation Guidelines, check out this FAO document.