Food Over Medicine (2 page)

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GLEN MERZER:
Pam, how would you characterize the overall state of the health of Americans as a population? How sick are we?

PAM POPPER:
Very sick and very overweight. It’s far worse than most people believe.

GM:
But aren’t we living longer than before?

PP:
We’re not living longer in good health; we’re living fractionally longer with diseases that compromise our quality of life and that cost us a fortune. We’re living longer with diseases like diabetes and Alzheimer’s, which are both seeing explosive growth in the number of diagnoses. And, in fact, we’re not living that long at all; we’re around thirty-sixth among nations on the longevity charts, tied with our very poor neighbor Cuba. We’re in a health crisis. We spend more money by far than any other nation on health yet we have miserable health outcomes. Some people don’t perceive it that way. We have to change their minds.

GM:
What’s making Americans so sick?

PP:
Our food. And I say that for two reasons: One, we have excellent data on populations with lower disease rates and we know that their eating patterns are different than ours. Two, we have excellent data on the rare physicians who use diet as an intervention tool, showing that when people adopt the right diet, they often eat their way out of their diseases. Diet is clearly the problem.

GM:
Has a nation ever existed that is fatter than America today?

PP:
Never in recorded history have we seen such obesity. We’ve set the record. And it’s going to be tough to beat.

GM:
There’s been a lot of attention paid to obesity recently. Do you see any signs of improvement?

PP:
It’s getting worse, unfortunately. When I was doing research for
Forks Over Knives
, I was looking at obesity statistics; the statement was made in the film that 40 percent of Americans are obese. If you take a look at the website of the Centers for Disease Control, the party line is that a third of the country is obese. Well, if you take a look at how we categorize obesity and overweight conditions in our country based on body mass index charts, we’re basically saying 21 to 24 percent is normal, 25 to 29 percent is overweight, 30 percent and higher is obese, and 40 percent and higher means you’re morbidly obese. Well in India, 21 to 24 is overweight, not normal.
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This is also the approach in Canada
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and many other countries. If you pick up the population of the United States and plop it down in the middle of India and other countries with higher standards than ours, our obesity rate would approach 60 percent.

GM:
So there’s a potential way out of the crisis. Just lower our standards a little more. Define “overweight” as “twice as fat as an obese Indian.”

PP:
It’s almost unbelievable. No other population has ever had such unlimited access to so many bad foods to become this overweight. And no population has ever been as misled as ours by a perverse system of incentives in food manufacturing, the advertising industry, and the medical field. So we’ve eaten ourselves into the dubious distinction of being the fattest population in recorded history; now we’ve got to figure out how we’re going to teach more than three hundred million people to eat their way out of this terrible state.

GM:
I heard a report on NPR about the healthiest, fittest, and leanest state in America: Colorado.
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The reporter went on about all the joggers, the bike paths in Boulder, and the skiing in Aspen. Then he actually said, “In fitness-crazy Colorado, the obesity rate is only 21 percent.”
⁴

PP:
So that’s only about a million people.

GM:
Yup. That’s our skinniest population. That’s as good as it gets. And, credit where credit is due, only one in four children in Colorado is overweight or obese.

I’ve noticed that people just assume that it’s normal to gain weight as you age. Friends who were 160 pounds in college hit middle age and they’re 200 pounds. Is there any reason why a fifty-year-old should weigh more than he did when he was twenty or twenty-five?

PP:
The only reason why a fifty-year-old would weigh more than he did when he was twenty or twenty-five is that his diet and lifestyle finally caught up with him. Youth will overcome a great number of indiscretions. That’s why people tend to get cancer a little later in life; it takes that long for the dietary habits to catch up. It’s simply diet and lifestyle habits catching up, with the major habit being exercise, or lack thereof. I’m fifty-six years old and the vast majority of people my age are not doing the right amount of exercise; some of them don’t exercise at all. Gaining weight is not a normal function of aging. There’s no reason why you can’t stay lean and physically active into your nineties and be healthy.

GM:
What would you say are the leading causes of our unmatched record of obesity?

PP:
First, there is an overall confusion about food and the way that people are taught to eat from a very early age. We have strange ideas about food in this country. One is the idea that moderation is the key to success, that you can eat almost anything you want as long as you eat it in moderation.

GM:
I hear that a lot, though no one ever says it about hemlock.

PP:
I attended a wedding last night and food was the topic of the table. I wasn’t eating 90 percent of what they served, and the guy next to me said, “Everything in moderation is okay, so I’m just going to have a little bit of this stuff.” Well, it was a little bit of a bunch of horrible things that added up to probably 2,500 calories, 2,000 of them from fat. You know, that’s not moderation—that’s a diet that kills people. We have a lot of misbegotten ideas about food, many of which come from the government, national health organizations like the Academy of Nutrition and Dietetics, and other professional groups.

Another part of it is the availability of rich, inexpensive food. If you go back several hundred years, you used to have the wealthy and poor eating vastly different diets. The wealthy ate rich food with lots of calories, with the result often being health and weight problems. The poor peasants couldn’t afford rich food so they lived on potatoes and vegetables for most of the year. A few times a year they’d have a festival and roast a pig, but then it was back to vegetables and potatoes. The fact that they didn’t have the economic wherewithal to eat as the wealthy ate was protective for them; it kept them leaner and healthier than the wealthy. Today, most Americans can afford to eat meat and animal foods—things that used to be reserved for the wealthy. They’re eating all of this calorie-dense animal food and processed and packaged food, day in and day out. And it’s often a lot easier and sometimes cheaper in the inner city to find Kentucky Fried Chicken or McDonald’s than fresh produce, so many people find themselves almost trapped into obesity. The cost of many animal foods is effectively kept low by federal farm subsidies, so our tax dollars are being used to skew our diet in the direction of the very foods that make us sick and obese.

When you eat this calorie-dense food, as Doug Lisle says in the movie
Forks Over Knives
, “People have to overeat just to be satisfied.” If I’m going to try to fill my belly with cheese and potato chips, I’ve got to eat four thousand calories of it to accomplish that goal. You can’t eat those foods without becoming overweight because you’re forced to overconsume from a caloric standpoint. That’s why we have an obesity epidemic in this country. Then you add to it the sedentary lifestyle of most people, and it’s no wonder we’re gaining weight at an alarming rate.

GM:
Are you forced to overeat those foods to feel full because they’re deficient in fiber?

PP:
Yes. There are two mechanisms by which people experience what we call satiety: stretch receptors and nutrient receptors. Stretch receptors in the stomach tell you that the bulk of the food that you ate is sufficient, and that’s where fiber is really helpful; if you eat a bowl of lentils and rice with fourteen grams of fiber, you’re going to feel full. In fact, you couldn’t overeat it because if you tried to eat four bowls of it, you’d explode. On the other hand, if I’m eating calorie-dense, fiber-deficient food (such as a turkey sandwich and potato chips), in order to activate those stretch receptors, I’ve got to eat an enormous amount of calories. We only feel satiety when the stretch receptors and the nutrient receptors in our stomach tell us that we’ve had enough bulk of food and calorie concentration. So with these calorie-dense, nutrient-deficient, and fiber-deficient foods, in order to activate those stretch receptors, you’ve got to eat a gargantuan quantity of calories to accomplish that goal, sometimes thousands of calories in a single meal. When you take into consideration that an average adult may need only two thousand calories per day, you can see the problem. It’s easy to consume half of this in one meal.

GM:
Tell me about the nutrient receptors. How do they work?

PP:
They tell you if the calorie density of the food is adequate. That becomes important because just as you can overeat from a caloric standpoint by eating the standard American diet with animal foods and processed foods, you can also undereat by structuring a plant-based diet the wrong way. I see this often with people coming into our classes, people who have seen various movies or read articles and decided, “I’m going to eat a lot of fruits and vegetables. In fact, I’m going to structure my entire diet around fruits and vegetables.” So they eat fruit for breakfast, have a big salad for lunch, and a big salad for dinner. After about three days of that, they’re ready to chew their desk up at the office and can’t sleep at night from the rumbling stomach. They’re uncomfortable all the time and have a nagging hunger. Even when their stomachs are full of a pound and a half of vegetables, they have this nagging feeling of needing more food. Why? If I eat a pound and a half of vegetables, my stomach is going to be full from a bulk standpoint, but my nutrient receptors are going to say, “One hundred fifty calories? Gosh, I don’t know if we can keep this human operating for another four hours on 150 calories!” I may be full from a fiber standpoint, but I’m not doing well based on my body’s perception of the calorie density of the food. So we advise people to include a lot of grains and legumes and potatoes in their diet because they add calorie density to the meals without adding lots of fat and too many calories. Nature’s perfect plan for humans.

GM:
So that’s the argument for having starch as a staple of the diet?

PP:
Well, you have to. If you don’t, here’s what happens to people who try to live on fruits and vegetables. They go through what I call the “honeymoon period,” when they benefit from what they take out of the diet. When they remove animal and junk foods from their diet, they feel great. They lose weight, their skin clears up, their headaches go away, and they say, “Boy, this is the greatest thing since right turn on a red light.” However, within a few weeks they start to feel fatigued because the effect of the calorie deficiency sets in.

What a lot of people will do then is to start adding dried fruits, nuts, or oils to their diet. There are a lot of unhealthful plant-based options people choose to increase the calorie count. Over time, those people will develop health issues, generally speaking, as much as the meat eaters will. A plant-based diet won’t work effectively if you don’t do it right. And just eating fruits and vegetables is one of the ways that people can mess it up for themselves and a major reason why people revert to their old eating patterns. Then they say, “Well, this diet must not work. I have to go back to what I was doing before. It may not have been the best thing based on what I read in so-and-so’s book, but at least I was able to stay awake all day and I was able to sleep at night because my stomach wasn’t rumbling.”

GM:
The word “starch” seems to have a lousy public relations guy. People always have terrible things to say about starch. Dieters say that they’re trying to avoid starchy foods and that they gain weight whenever they eat starch. What’s the deal here? How can the type of food that actually helps people lose weight and stay healthy have such a bad reputation?

PP:
That’s because there are different sorts of foods that get labeled as “starch,” and because starch often travels in bad company. In other words, people slather sour cream on their baked potato or olive oil on their pasta or pesto on their rice. You walk into a Mexican restaurant and instead of having the healthy starch of beans and rice, you order refried beans with lard inside a burrito with cheese in it—a 1,500-calorie, fat-laden Mexican dish.

Let’s posit a hierarchy of starch. The healthiest starch comes from whole, unprocessed foods, such as whole grains, potatoes, sweet potatoes, yams, corn, and so forth. The next healthiest but suboptimal starch comes from broken grains, also known as flours. Whole wheat bread, for example, is denser and more caloric than wheat berries in their original form, but whole wheat flour itself is not inherently fatty or unhealthy. If you’re trying to lose weight, staying away from broken grains is probably a good idea because broken grains are more concentrated in calories and generally don’t have as much fiber as whole grains, so they’re absorbed quickly in the system. The worst starch comes in refined foods and is combined with fats and sugars in products like muffins and cake. These starchy foods will put weight on you fast, but it’s largely because of the added fats and sugars. People are misunderstanding the nature and importance of starch if the word conjures in their minds the image of donuts. It should conjure the image of yams and corn and rice.