Americans are rightly concerned about the wide variety of pathogens that regularly turn up in foods common to most diets.  Who wouldn’t appropriately worry about an array of bugs that can induce serious short-term and even long-term health impacts from a wide spectrum of what Americans eat on a regular basis?  But the bigger worry ought to be about the non-contaminated foods we build our diets around that have been implicated in many of the leading causes of death for Americans.

Dietary and lifestyle factors in the US are responsible for death rates that exceed most other Westernized countries.  Primary preventable causes of death include: smoking (465,000 per year), hypertension (395,000), obesity (216,000), physical inactivity (191,000), high blood glucose levels (190,000), high levels of low-density lipoprotein cholesterol (113,000), and other dietary risk factors also mean that major changes in diet combined with changes in health care could make huge differences in our population’s health.[1]

Indeed, four of the ten leading causes of death in the U.S., including the top 3, can be influenced by diet: coronary heart disease, cancer, stroke, and diabetes.  Critical dietary factors associated with these conditions include those that are too high in calories, fat, saturated fat, cholesterol, and sodium or too low in fiber-containing foods.[2]

Diabetes treatment now costs over $100 billion annually, a figure that is projected to triple by 2034 to an annualized figure of $334 billion.[3] About 90% of those with diabetes have type 2 in which the pancreas produces insulin but the body becomes increasingly resistant to insulin’s ability to break down glucose.  A leading risk factor for type 2 diabetes is being overweight.

There is, of course, an ongoing torrent of specialty diets which often feature fundamentally opposing approaches to what constitutes healthy eating.  For instance, the Atkins Diet focuses on consumption of high levels of protein and fat with few carbohydrates; the book The China Study insists that all animal protein is bad and that fruits and vegetables hold the key to a healthy life; while Gary Taubes’s Good Calories, Bad Calories takes issue with the notion that fat is bad and places the blame for America’s diet-related health maladies on the amount of refined carbohydrates we eat.  This idea that refined carbohydrates (sugar, high fructose corn syrup, white flour, French fries) are particularly bad rests on research showing that they play havoc with the body’s blood sugar (glucose) levels and provoke storage of excess fat.  Another potential side effect of refined carbohydrate consumption is that it may actually increase feelings of hunger leading to a cycle of over consumption.

And if it sounds like a lot of your favorites are on the “eat less” list, consider that alcohol is another problematic consumable. The potential virtues of red wine aside, alcohol itself is devoid of nutrients.  And while pure alcohol contains no carbohydrates (the sugars present in grain are consumed during distillation) it is highly caloric (7 calories per gram versus 4 calories per gram of carbohydrate).  Alcohol is also preferentially metabolized and may slow normal fat metabolism.  The intermediate byproduct of alcohol metabolism in the liver–acetaldehyde–is toxic and is associated with several types of cancer.

There are legions of Americans who assume they are avoiding the dangers of a diet featuring carbohydrates in the form of high fructose corn syrup by consuming vast quantities of diet drinks.  Not so fast.  An intriguing commentary in the Journal of the American Medical Association makes the case that while artificial sweeteners have the potential for at least short term weight loss when substituted for sugared foods, the long-term effects may be just the opposite.[4] This can occur due to the ability of intense sweeteners to:

…cause taste preferences to remain in, or revert to, an infantile state (ie, with limited tolerance for more complex tastes). Individuals who habitually consume artificial sweeteners may find more satiating but less intensely sweet foods (eg, fruit) less appealing and unsweet foods (eg, vegetables, legumes) less palatable, reducing overall diet quality in ways that might contribute to excessive weight gain.[5]

Of particular concern is the ability of diet drinks, consumed in the absence of other foods, to produce “a dissociation between sweet taste and calorie intake.”[6] Limited research on rats suggests that this may disrupt hormonal and neurobiological pathways leading to long-term increased calorie consumption and weight gain.  Long-term studies on humans are needed to “flesh out” this hypothesis.

Few of us probably sufficiently ascribe the quality of our diet to our basic state of health.  And while it is very easy to become overwhelmed with the endless claims of various diets, there are a few truths that ought to inform how we eat: eating too much is bad and eating too much of certain things like highly refined carbohydrates is particularly bad.  A diet high in saturated fat and cholesterol is not good; a diet high in non-starchy vegetables is good, as is one that features whole grains and lean proteins.  Moderation in all things is very good.

And so as 2010 unfolds, take time to consider the fundamentals of your diet and the critical food safety issue it represents.  Contaminated foods can certainly result in very serious illness, but a good diet can help ensure long-term health.

1.  Danaei G, Ding EL, Mozaffarian D, et al. The preventable causes of death in the United States: comparative risk assessment of dietary, lifestyle, and metabolic risk factors. PLoS Med 2009;6:e1000058-e1000058.
2.  Frazão, E., The American Diet: A Costly Health Problem FoodReview (202) 219-0911(1996).
3.  Huang, ES et al. Projecting the Future Diabetes Population Size and Related Costs for the U.S. DIABETES CARE December 2009 vol. 32 no. 12: 2225-2229.
4.  Ludwig DS, Artificially Sweetened Beverages Cause for Concern.  JAMA. 2009;302(22):2477-2478.
5.  Id.
6.  Id.