Chapter 30: Essentials of Nutrition in Modern Health! - Part 3
Diets of Modern times !
History of Foods and Diets…
The history of diets is a rich tapestry woven with cultural beliefs, traditions, and advancements. These factors have continually shaped and reshaped dietary patterns, adapting to modern changes based on location, region, religion, and values. Food is not just sustenance but an integral part of our society, deeply rooted in our cultural heritage.
In the 19th century, Graham and Kellogg promoted whole, unprocessed foods, setting a foundation for future nutrition awareness. In the 1920s, as we noticed the macro and micronutrients as the causes of debilitating illness, the government started fortifying food with micronutrients. Hence, Scrunch programs started to provide nutritious food for developing kids to combat malnutrition started as the mid day meals.
People have eaten breakfast for millennia; however, breakfast gained significance as we started to industrialize and use machines. Hence, it can be categorized into pre-industrialized and post-industrialized, where eating breakfast in the morning has gained importance as people working longer hours needed enough nutrition to last all day. The way breakfast is consumed and marketed significantly changed after the World War 2, with a focus on convenience and commercial products.
After World War 2, the link between diet and disease became more prominent. Also, post-industrialization and nutrition awareness have started to create cereals to promote health. Marketed as the concept of just having breakfast to keep us healthy. Before this, it was more ad-hoc, but now it has become mainstream. School lunches became the norm. Cereals started to flourish. This was when McDonald's, or the fast industry, was in its infancy. During the '60s, after a study at Harvard showed fat intake was considered to be harmful to heart disease and caused deaths, the low-fat movement caught on fire, causing significant changes, making foods and dietary traditions, making highly sugary fast food and processed food start to the hits the shelves. The glory of making food at home and the sudden liberalization of women have created a detour to unhealthy processed foods; easy-to-make microwavable foods can now be consumed at home. The low-fat movement inadvertently spurred a reliance on processed, high-sugar foods and contributed to obesity rates; by the 1990s, diet culture and weight-loss trends dominated, with the Food Pyramid emphasizing a high-carb, low-fat approach.
In 1967, a Sugar Research Foundation-funded study published in the New England Journal of Medicine downplayed sugar's role in heart disease while emphasizing dietary fat as the main culprit. Harvard scientists, including Dr. Fredrick Stare, to conduct the review, which heavily influenced public dietary guidelines in the 1970s and 1980s. This led to the promotion of low-fat, high-sugar processed foods, contributing to rising obesity and diabetes rates.
A shift toward whole, organic, and plant-based foods reflected a backlash against processed sugary foods, and an interest in health and longevity had gained speed. Today, Americans navigate diverse diet trends influenced by digital media, with a growing emphasis on personalized health and environmental sustainability. These dietary shifts have influenced public health policies, food industry practices, and societal norms, impacting physical and mental health across generations.
In this ever-changing world, social media has run amok our hunger pangs. We can order any food from anywhere, which has created a shift in dietary patterns and excess caloric intake. As our nutritional patterns have shifted, so has our relationship with food. In the past, desserts were a rare commodity for special occasions. However, in today's world, we often eat without limits, increasing caloric intake. The excess is stored as lipids when we consume more calories than our bodies can burn, secondary to our sedentary lives. This onslaught of excess energy leads to increased lipid storage, later becoming a chronic disease, highlighting the importance of portion control and mindful eating.
Many studies have been conducted regarding dietary patterns and health; one famous one is the Mediterranean diet. People around this area tend to have lower incidence on coronary artery disease or heart disease compared American diets.
Diets of the Modern Times!
As we have seen on social media, millions of videos on TikToks or YouTube claim one diet is better. Some claim that diet reverses disease, some healthy patterns are associated with diet, and certain foods are bad. Our minds will scroll through these unending videos about food and health. Is the Bitter gourd juice better, or do I need to eat more chia, or can I just do the fruit diet, etc.? The list is endless, and videos make anyone watching this dopamine-craving frenzy.
The problem with consumption is that as we consume food, our bodies must digest it; if it's edible, we break it down. That's the power of the stomach. The food is absorbed after mixing with bile and pancreatic juices in the small intestine. However, our bodies must decide what to do with excess energy-rich, dense foods. If we eat in excess, the food has to be stored for utilization of the food in the future. Insulin, or the building hormone, is necessary to build or make us fat and increase energy. Until recently, we were hunter-gatherers, and the protective part of eating once or twice a week was to store abundant food, especially with insulin, making use of an increase in fat storage for future starvation. However, fast forward to the current times; there is no starvation that our ancestors were used to. Eating without actually feeling hungry might put us into energy storage mode. The starvation mode never comes. Hence, the excess energy continues to store the food and make us obese. If we eat less, the food is not stored and expended, ensuring weight loss. If we overeat processed food, colloquially junk foods.
The idea that food itself will cure everything has intrigued people for centuries. Instead of diets, if one sticks to eating any food in moderation, one can still be healthy based on one's body type. Also, the big problem with these diets is that they are very heterogeneous(different for various body types), which intrigued me more than anything. If one has eaten the South Asian heavy carbohydrate-loaded diet all their life, now put them in Italy and let them consume like Italians, like the Mediterranean diet. Do we see changes in our health?
Understanding the BMI is the first step; where are you in the journey of the weight determines what diets are the nutritions good for you. Nutritional science is hard to research as we cannot give half the patients the same food and half of the patients ad libitum. There are so many variables that have to be taken into account anytime we get into nutritional research. Most nutrition research has a lot of flaws and/or small studies with few patients. What one works doesn't work for another, as in the diets. Understanding our bodies, culture, and belief systems is much more than what diets we eat. Just realize what BMI you have. BMI gives a rough estimate of height and weight and closely estimates whether you are undernourished, nourished, or overnourished. Most of us fall into the over-nourished category (including myself). If you are underweight, which is rare, you must work on an excellent caloric diet. For the nourished bunch. Keep up the good work; make sure you continue to do a good job. Now, coming to the category along with me, we have much work to do.
First step ——> Check BMI (Height and weight) ——> If you are over nourished state or obese BMI >30 ——>Check RMR/ BMR(Basal metabolic rate-Amount of calories for life functions in a resting state) ——> If one needs to lose weight cut down 500 cal from the diet (suppose 2500 Kcal is daily requirement-cutting down the 500 Kcal per day will take 1 week to lose 1 lb)
The over-nourished category is where, as I have done the diagram in the previous chapter, anything excess we eat, especially the simple sugars, has to pack the energies, turning into fat for future power utilization. In this category, when we consume excess calories, especially sugar calories, our fat adiposity increases, causing weight gain. What happens this time of year, holidays, and heavily dense rich foods with excessive calories make our inch of belly go up by New Year, and then we wait for the resolution, which lasts less than a week(ha ha). All that excess energy that is being stored is hard to exit. We have to work in excess and eat less to cause us to lose weight.
To lose one pound of body fat, you need to create a calorie deficit of approximately 3,500 calories, as 1 pound of fat equals about 3,500 calories. The time it takes to lose a pound depends on your daily calorie deficit:
A calorie deficit of 3500kcal per week with achieving one pound weight loss. Hence, the best way to lose weight is to reduce calories from the diet. Also, this has been shown to lose weight consistently when we cut down calories from the diet by 500/day. If the average requirement is 2000 kcal for an average adult male, eating 500 kcal less will achieve 1 lb weight loss in one week. This is precisely what the Ozempic or Mounjaro are doing. They cause you to eat less, drop calories from your diet and lose weight. The more you stop eating, the more weight you lose. When you don't eat, your body will use the stored energy, causing the fat cells to empty out.
There is a calculation to calculate resting metabolic rate or basal metabolic rate, the amount of calories needed based on height, weight, and sex. Also, one can calculate total daily energy expenditure, which includes activity. I will cover these sometime, but I have a rough estimate of about 500kcal less, which is still the best bet for you if you want to lose weight naturally. Sometimes, it doesn't work for everyone, but it can be close.
Identify your state!
Undernourished state —> Increase nutritious calories.
Nourished state(make sure no skinny obesity) —> Continue, and kudos to you, keep up the good work
Over nourished state—> Calculate your caloric intake, identify how to increase your BMR, and understand the need for decreasing caloric intake. Only those with a caloric deficit(sometimes much more than caloric deficit) will be able to lose weight. The topic at another time.
In the next chapter, I delve deeper into the various diets studied and researched extensively. I pay close attention to the Mediterranean diet and DASH diet in Cardiovascular disease and have also reviewed Chapter 9 in detail regarding the benefits of this diet. Choosing a diet is easy but sticking with the diet is hard. Most diets do not work and return to their original state within a year. I would like everyone to look at their culture, belief systems, tastes of foods, home life, work environment, ease of time, Etc. There can be hundreds of variables. Identify and eat less processed food and more unprocessed food. Nowadays, we cannot avoid all the delicacies and rich, dense caloric diets, but at least we can minimize them, especially if you are overnourished. An unprocessed diet with 5 servings is recommended daily; this cuts down heart disease by half and other benefits, too.
Suman Manchireddy MD FACP FHM, Internal Medicine, Leesburg, VA.
Email : Care@ReliantMD.com
Disclaimer: This is purely informational and educational purposes only, seek medical advise prior to starting any testing or treatment regimen. The data presented here is researched extensively and has been condensed for a broader audience.