Based upon this equality of calories presumption, I have seen doctors ‘prescribe’ ice cream and other processed foods devoid of nutrients to children with growth deficiencies. Just as egregious, are the sugary chemical concoctions (Ensure, Boost and the like) served to severely ill patients in any American hospital under the banner of ‘medical nutrition’. Admittedly, financial interests play a role, but undergirding those interests is the long held belief that calories are all that matter; a belief, that I would argue, we as a society, are all too happy to accept. It is a simple idea; one that doesn’t require much thinking, and best of all, lets us eat anything we want as long as the calories are balanced in our favor. Who among us has not convinced ourselves of the ‘healthiness’ of some low calorie treat?
The Wonder of Fortified Foods
A similarly troubling assumption about food equivalency and one I see all too often is that enriched and fortified foods are nutritionally equivalent to native foods. This is certainly the reasoning behind the hospital protein drinks where calorie density plus fortification equals nutrition. But does it really? Do we really believe so strongly in the powers of modern industrial food chemistry that the foodstuffs we produce with seemingly infinite shelf lives, all manner of chemically derived flavor enhancers and colors, loaded with corn syrup, trans fats and other delectable substrates are somehow converted into ‘healthy’ foods by the magic of fortification? Moreover, do we really believe that those processed substrates appropriately fuel the mitochondria?
Just last week, some internet troll tried to argue that there was no such thing as vitamin or mineral deficiencies in modern America, citing food fortification programs as his example. Similarly, a few months ago I spoke at a conference on this topic and the physicians in the audience were incredulous about the idea of nutrient deficiencies for the same reasons. Even prominent researchers bang the food fortification drum. Consider this study.
“Only a small percentage of the population had total usual intakes (from dietary intakes and supplements) below the estimated average requirement (EAR) for the following: vitamin B-6 (8%), folate (8%), zinc (8%), thiamin, riboflavin, niacin, vitamin B-12, phosphorus, iron, copper, and selenium (<6% for all).”
It seems that we have solved malnutrition once and for all. Foodstuff fortification equals nutrition. You can have your Oreos and meet minimal nutrient requirements. End of story.
Or is it?
Dig a little deeper and we see that we have done nothing of the sort. About the same study cited above, a secondary study said this:
“Without added nutrients, a high percentage of all children/adolescents had inadequate intakes of numerous micronutrients…”
“Among all age/sex subgroups, when considering only intrinsic nutrient intake from foods, approximately 25% to 100% had inadequate intakes of numerous nutrients, including vitamins A, D, E, folate, and calcium. Among females aged 14 to 18 years, approximately 23% to 92% also had inadequate intakes of thiamin, riboflavin, niacin, vitamin B-6, vitamin C, phosphorus, magnesium, iron, and zinc…”
“When nutrient intakes contributed from fortification were added, the %<EAR for vitamins A, D, B-6, C, the five enrichment nutrients, and zinc shifted sharply lower.”
Translation: most of the nutrients contributing to the presumption of nutrient sufficiency come from fortified food products and not actual food. So while fortification provides a bare minimum of nutrient and staves off outright malnutrition, can it really be considered healthy? I don’t think so, but when we buy into the nutritional equivalence, calories in, calories out model of health, what we are saying is that this:
Is nutritionally equivalent to this:
We are saying that it does not matter what types of foods we consume so long as they are fortified and so long as the calories balance. We are back to the notion that prescribing ice cream to spur growth in kids, fake ‘nutrition’ drinks for the ill and elderly, and all manner of other convoluted dietary machinations are okay, somehow healthy, and even, logical.
Of Fructose, ATP, and the Magical Mitochondria
If we take this logic one step further, we arrive at the door of that magical mitochondrial black box that will take any fuel we give it and turn it into ATP. Admittedly, to some degree that is true. No matter the origins of that fuel, mitochondria will break it down into its carbon skeleton and through a series of reactions produce ATP. That’s their job. The question, however, is at what cost. That is, are these food products the most efficient and desirable fuel substrates? More specifically, what is the energy cost to convert garbage food into ATP. Consider something as simple as fructose and how it moves through the glycolytic machinery:
“The flow of fructose into the glycolytic pathway gives the appearance that fructose is a benign fuel suitable for human (over)consumption; in reality, fructose’s conversion to fructose-1-phosphate drains ATP from the cell, promotes a dramatic inflammatory response, and leads to clinical features of insulin resistance, hypertension, and metabolic syndrome via several mechanisms, one of which is increased production of uric acid.” Alex Vasquez
Although the mitochondria will convert these fructose dense foodstuffs into ATP, there are costs; costs that can only be accounted for if one moves beyond the black box model of mitochondrial metabolism. And yes, I know, fructose comes in fruit and vegetables too, but where most folks get their fructose is not from fruit or vegetables but in the form of high fructose corn syrup, the staple sweetener in all processed foods.
Fortified Versus Real Food
The way I see it, there are at least two issues to consider when assessing the healthiness of food. Firstly, and as I mentioned previously, the mitochondria in the different organ systems require different macronutrients, one a well balanced diet from real food would provide. In contrast, a diet derived from starchy, high fructose corn syrup sweetened and chemically processed carbs, no matter how strongly fortified will never be able to match a well balanced diet of whole foods.
Second, to get from macronutrient to ATP takes a whole host of nutrient co-factors, vitamins and minerals, to power the enzymes responsible for this process. Take a look at the figure below from our book. There are 24 vitamins and minerals needed to convert what we eat into ATP. More, if you consider all of the ancillary processes not charted here.
Even when the scales balance on our calories in, calories out model, they do not balance in the mitochondria and health depends entirely on the mitochondria. Diets heavy in processed foods not only lack the basic macronutrients, typically protein and good fats, but the minimal nutrients provided by these foods are neither sufficient to power the mitochondrial enzymes tasked with converting these products into ATP, nor are they sufficiently ‘nutritious’ to overcome the ATP costs of clearing all of the garbage that these products contain. This leaves us with decrements in ATP, and in a state of constant metabolic distress, which itself demands additional energy to resolve. It is a downward spiral to be sure; one where the use ice cream or pseudo-nutritional drinks only hastens.
What do the Mitochondria Need?
A diet rich in real, organic foods is a good start. Look what happens when someone who is disabled by a chronic, neurodegenerative illness changes her diet. Health becomes possible.
Dr. Terry Wahls: Minding your mitochondria
Although a change in diet may not be all that is required, it is the foundation upon which health can be built; a foundation that is just not possible when ice cream is prescribed as nutrition.
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This article was first published on August 13, 2018.