Appetite for Destruction: Food the Good, the Bad and the Fatal

Acknowledgements

This project rose from the ashes of our work on the book Health Cheque, so thanks firstly go to all those who bugged us to maintain our interest in this area. We are acutely aware that having two economists hanging around can at times be annoying. The area of food and health is full of facts that can be difficult to swallow, but thankfully New Zealand is blessed with world class experts. Thanks to all the nutritionists, NGOs, Government officials, businesses and academics that contributed their views to this study. In particular we would like to acknowledge Sir Peter Gluckman, Sue Kedgley, Craig Bell, Professor Boyd Swinburn, Associate Professor Cliona Ni Mhurchu and her colleagues at Auckland University, and finally Professor Jim Mann, Dr Kirsten Coppell and their many colleagues at Otago University.

Getting the complex issues surrounding food across in a (hopefully) accessible way has been a considerable challenge. We have had to write and rewrite the book several times to break it down into bite sized pieces, and thanks have to go to John McCrystal for helping us make it digestible. We are also indebted to our taste testers; Sue Kerr, Penny Deans, Andrew Gawith, Talei Haywood, Logan Cowdell, Tobias Heine and Ruby, Jessi and Jo Morgan.

This project has been funded by the Morgan Foundation (http://www.morganfoundation.org.nz/) as part of its goal to stimulate debate on important public issues facing New Zealand. We don’t ask that you agree with us on everything, but we do ask you to talk about it. Thanks to the Foundation for making the study possible.

Finally all errors and omissions are of course our own and none of those mentioned above can be held accountable for the views expressed.

Designed by typeface ltd. Printed in China by Toppan Printing Co., (China) Pty Ltd. First published in 2013 by The Public Interest Publishing Company Ltd (PiP).

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Copyright © 2013 by The Morgan Foundation.

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Preface

Get this. If you listen to some experts, the evidence suggests that the youth of today will be the very first generation in recorded history with life expectancy lower than their parents. And if they achieve this dubious distinction, then it won’t be hard to find an explanation: food. It’s an awful prospect, made all the worse because it’s completely preventable. All we have to do to head off this problem is get real about what matters when it comes to food and nutrition.

In our 2009 book Health Cheque: the truth we should all know about New Zealand’s health system, we likened our health system to an iceberg: the bit we see – hospitals, doctors and operations – is only 10% of the picture. What we don’t see is that 90% of our health is determined by our lifestyles and environment. If our aim is to live longer, healthier lives, then we should be putting more effort into preventing illness (or at least nipping it in the bud early). Not only will this save many millions being poured into hospital procedures, it would extend our healthy lives. Compared to hospital interventions, these early, preventative changes generally create four times the benefit to our health for each dollar invested.¹

There is pretty good evidence that all the extra money pumped into hospitals in recent decades isn’t actually making us live any longer. In fact we could get the same health benefit from adopting a healthy lifestyle (eating better, quitting smoking, easing up on the grog and exercising a little) as we would from doubling our spending on hospitals.

In this book, we focus on food. Smoking has been largely knocked on the head in New Zealand, so the major threat to our health is now the shortcomings of our diet. What and how we eat drives most of our biggest killers – diabetes, strokes, heart disease, even cancer. So if prevention of illness is the path to a less costly public health system, then food seems like an obvious area to focus on.

Of course it isn’t that easy, otherwise we wouldn’t have needed to write a book about it. Smoking is a much simpler problem to solve than food; we don’t need to smoke, but we have to eat. Hence we need to identify what the problem is, why and how it has come about and what we can do about it. Food is a difficult topic because we don’t know that much – the sum of scientific understanding isn’t too great. And of course, since humankind abhors a vacuum, a gaggle of diet kooks have moved in to fill the gaps in our knowledge with myths and misconceptions. Sorting through that mess was another reason for this book.

Eating well has similarities with retirement savings. Both have long-term benefits but are, for many, too boring to bother with. With our finances many of us are myopic and prefer to live in the now, running up debt instead of saving. With food, our predilection is for scoffing donuts and downing fizzy drinks instead of eating well; we only worry about our health when it’s gone, and then we move heaven and earth to fix it.² This short sightedness would be fine if we didn’t expect someone else to come along and pick up the tab for us when we retire, or give us a bypass when our arteries clog. Having our cake and eating it loads a burden onto others –taxpayers, notably – and that burden is getting bigger and bigger.

Nutrition is complex, and much of what any given expert says is likely to be contested, sometimes hotly. At times we have skated lightly over the intricacies of the subject and the niceties of the various debates within it. This has been necessary for the sake of readability and because at the end of the day we are economists, not nutritionists. We don’t pretend to present — or to possess — a deep grasp of the science of food and nutrition; rather, we hope to give you sufficient, basic, reliable information to understand the nature of the problem, and the basis of the potential solutions and advice that we tender. We are laypeople writing for laypeople, and so we make no apology if we are occasionally simplistic. And where, on occasion, we are forced to use the lingo — the scientific terms and high-flown jargon — there is a glossary at the back to help.

The other apology we deem it unnecessary to offer is for the economic focus of the book. We came at this problem as economists, seeking the solution to a problem in economics. For most people, and especially for people who struggle with their diet, the whole subject of what kind of food and how much of it we eat is deeply, deeply personal. We are not unaware that much of what we have to say seems a strangely bloodless way of tackling a topic that is the source of acute heartache, anxiety and even depression for many. For some people, reading the discussion that follows will be much like it would be for a war veteran to walk the battleground where he was scarred in mind and body with someone who is only interested in the technology and tactics deployed there. Suffice to say: we hear you. We hope that there is something here for you, even if it is only a greater understanding of the social context of your struggle with food and fads.

INTRODUCTION TO SECTION ONE:

What’s the Beef?

Food, glorious food! Don’t care what it looks like – Burned! Underdone! Crude! Don’t care what the cook’s like. Just thinking of growing fat – our senses go reeling One moment of knowing that full-up feeling lyrics from Oliver!

Hands up who knows what it’s like to be hungry? Not just peckish, not just tempted by some delectable treat, but really, really hungry.

Hunger was a defining reality for most of our ancestors. Over most of humankind’s existence, we struggled to scrape together enough food just to survive. Our species survived and flourished by not being too picky, by being willing to eat pretty much anything. Occasionally, when running out of options, we even started eyeing up other humans for a feed. Such adaptability when it came to diet might well have been our greatest evolutionary leap, right up there with the opposable thumb, speech and televised sport. It allowed our species to survive crises when previously reliable foods disappeared, and flourish on totally different diets. Other species weren’t so lucky and their pickiness or inability to adapt led to their extinction. The only constant among the huge diversity of the diets of early humans was a taste for foods that were high in energy, like sugar and fat. We sought these — and still seek them — in order to feed our big brains; the very brains that make us different from the rest of the animal kingdom.

What’s more, our ability to adapt to many different diets enabled our migration around the world, meeting our nutritional needs from whatever wild plants and animals happened to be growing around us. No exotic, out-of-season fruit and veg for us: we ate local!

Since those ‘happy-go-lucky’ hunting-gathering nomadic times, our food supply has undergone two massive changes. First, our species mostly settled down, forming villages, then towns and then cities. This change was made possible by the development of agriculture and horticulture. No longer did we have to move about foraging for our food: we could grow it or herd it at our own back door. This set of innovations saw us start consuming dairy foods, alcohol and grains. Settling down provided increased safety from predators and fostered ever larger populations, with all the culture and graffiti that brings. But there were downsides, besides the graffiti. Farmers worked a lot harder than hunter-gatherers, they were more prone to famine (because all their bets were on the one crop and in one location), and the food they produced was nutritionally poorer (less protein, fewer vitamins and minerals) than the varied diet of a hunter-gatherer. The size of the average human decreased in the transition.³

The second major experiment that we, as a species, have been conducting with our food has been going on since the Industrial Revolution. This has been the tendency to get other people (or factories) to make our food for us. Now we don’t even need to farm – we can sit in offices instead! Travelling that road has transformed our food and, according to that law of nature that holds you are what you eat, it has also transformed us. Outsourcing food production has dramatically raised our consumption of refined sugar, salt, grains and vegetable oils and an assortment of additives. Three quarters of the modern diet would be unrecognisable to hunter-gatherers.⁴ Of course, it cuts both ways: we now turn our nose up at some hunter-gatherer staples, such as bugs.

Together these two experiments have delivered us an abundance of cheap and convenient food. For much of humanity, the security of food supply is no longer an issue, especially in the affluent West. Surrounded by food, with bright packaging and sexy brands winking at us from every shop window, most of us no longer have to worry about where our next meal is coming from. A brisk swish of the credit card and it materialises. Our dreams are no longer haunted by the spectre of famine. Our bellies no longer rumble so loudly we can’t sleep. Instead, our poor tums are more likely to be stretched by the sheer quantity with which we stuff it. People still starve, of course, but that’s not due to any global food shortage: we’re buried in the stuff.

Yet that additional quantity of food has come at a price – one that doesn’t appear on the label. By stuffing the food full of calories and stripping it of the nutrients it contains in its natural form, manufacturers found they could create tasty foods that don’t go bad. This allowed them to mass produce food – which meant cheap food for us and big profits for them. Unfortunately more calories and fewer nutrients mean the quality of that food has fallen – to the extent that some question whether it should still be able to be called food at all. In fact, in the United States, traditional foods once had to bear the moniker ‘imitation’ if their recipe was so much as changed, but this regulation was loosened in the 1970s, which allowed the whole food processing industry to bloom (more on this in Chapter Eight). We reckon that calling these foods ‘imitation’ was more honest. In this book we will refer to food processed beyond recognition of its natural state by the more straightforward term: ‘fake food’.

While we have moved on from our forebears’ diet of wild meat, berries and leafy greens, the boom in gastronomic supply has happened far faster than the process of genetic adaptation. Our bodies and metabolism remain designed to search out and scoff hard-to-get, high-calorie foods (sugar and fat), but these are longer hard to get. So here we are – marooned with genes that perfectly suit us to a dog-eat-dog world, in a world where gulping hot dogs is just so doggone easy.

In the year 2000, for the first time in our evolution, the number of overweight people in the world equalled the number of underfed – both cohorts stood at a little over a billion.⁵ Yes indeed, we have come a long way. This fact neatly summarises the deal we have struck with the devil over our food supply – in exchange for abundant fake food we have taken on a whole host of health problems – the so-called diseases of affluence.

The rise of diet-related diseases gave birth to another industry; dietary kooks, who have succeeded only in making themselves money and confusing us all. One of the first kooks off the rank was Seventh Day Adventist John Harvey Kellogg, who was obsessed with healthy bowel motions. The health tips at his Battle Creek ‘Sanitarium’ urged followers to abstain from meat, an evil that was right up there in his reckoning with masturbation (the victim of which, he famously quipped ‘literally dies by his own hand’) and instead to indulge in a high-fibre diet punctuated with bouts of exercise and enemas of water and yoghurt. Yes, this Kellogg is the same fellow who invented cornflakes and whose name is plastered all over half the cereal aisle to this day: Lord knows how CocoPops would rank against the sin of self-pleasuring! One of Kellogg’s employees, Edward Halsey, emigrated to New Zealand and founded our own Sanitarium brand in 1900, largely based on Kellogg’s principles — although Sanitarium have probably managed to stick to the original vision rather better than Kelloggs (compare the sugar content of their respective top selling children’s cereals: Weet Bix and Coco Pops).

Horace Fletcher was another popular dietary figure, who advocated avoiding meat and chewing each bite of food 32 times before swallowing: ‘Nature will castigate those who don’t masticate.’ Catchy by-line, Horace, although the potential for all sorts of conflict with Kellogg’s creed could be avoided only by very clear diction. Fletcher’s moment in the sun was followed by an economist named Irving Fisher, the same Irving Fisher who famously stated a few days before the 1929 stock crash: ‘Stock prices have reached what looks like a permanently high plateau.’ His nutrition ideas turned out to be longer lasting: he invented the idea of counting calories.

The current bunch of nutritional ‘experts’ make these guys look sane. Since World War II, dietary and nutrition advice has proliferated faster than campylobacter in a battery-farmed chicken left out in the sun. On the back of the anti-smoking movement came the Fat Police. Noting that people with heart disease had fatty deposits collecting in their veins, they concluded we had to eat less saturated fat. So how come we got fatter despite eating less fat? Next, we had the all-conquering Atkins Diet which had every celebrity you cared to name starving off their fat reserves by shunning carbohydrates and wolfing down lamb chops (protein and fat) instead. Then there was the Paleolithic or ‘Caveman’ Diet, which shuns any food a Neanderthal wouldn’t recognise, or the Sugar Busters Diet, that simply cuts out refined sugar. Meanwhile, you’ve got the holier-than-thou vegetarians, vegans and even raw vegans and fruitarians looking askance at the public’s profligate meat-eating ways from the sidelines.

If you follow the advice, you’re liable to be swept up in an avalanche of so-called ‘superfoods’ such as quinoa and chia, and supplements. The list of daily vitamin requirements you are supposed to take now looks like a game of nutrient Scrabble, and the range of minerals we are supposed to eat makes you wonder if you should be licking rocks for your dinner. And then, beware: here come the toxins! Fish is high in Omega 3 and selenium, but watch out for large fish like sharks and tuna which contain too much mercury. Eggs have gone from nutrient gold mine to killer and back again. Fruit and veges are good for you, but watch them for pesticides and genetic modification. Margarine is better for you than butter because it contains unsaturated fats… but wait! Scratch that. Margarine is worse for you because the chemical hardening process used in its manufacture creates trans fats.

And so it goes. In fact, the endless conveyor belt of fads and diets amounts to a whole new industry: food fashions. They have ended up being just as self-serving and dangerous for our health as the fake food they were trying to save us from. Each dietary fad comes amid a blizzard of pseudo-scientific jargon and misinformation, such random facts as there are simply confirming that a little knowledge is a dangerous thing. And too often, unbalanced but trendy diets have catastrophic consequences.

No wonder we are confused. It is time to cut through the jargon, advertising and misinformation to the core of the issue. That is where this book comes in. And the central point of this book is the one thing that all the dietary kooks can all agree on: we need to stop eating fake food and get back to basics. There you go – if you are skimming this in a bookstore looking for the punch line, you can save your money and put the book down before the security guard manhandles you.

Our charge is that fake food is killing us. This book will set out our case, a bit like a whodunit. We start in Section One by looking at the case to be heard – that eating fake food causes poor health and early death. Chapter One shows that the driver of poor health is eating too much food energy (calories) and not enough of the nutrients that help our bodies function. Chapter Two hunts for the murder weapon, which turns out to be fake food. Chapter Three explores whether this is a murder or suicide – how much responsibility should we take for our own demise? Lack of information, hormones, genes and our environment all make it difficult to pin individuals with full responsibility.

Of course, our genes and hormones haven’t suddenly changed to cause the problem, so what has? In Section Two we look at the evidence that the change has been the rise of fake food. In Chapters Four, Five and Six we take an in depth look at three industries: bread, meat and milk, and sugar and salt respectively. In each of these industries manufacturers have worked hard to provide us with an abundance of cheap, convenient and safe (in the sense that it won’t poison you) food. In each case this has led to our food being stuffed full of calories and stripped of its goodness. You simply can’t have it all.

In Section Three the book concludes with sentencing; our suggestions to lock up fake food and rehabilitate our food supply. How can we cut through the endless see-sawing of fad diets and bogus advertising? What can we do to encourage a balanced approach to food that avoids putting our health at risk? We look at what we could do to help our kids establish healthy eating habits, as well as to educate and inform the public. Finally we look at some of the more heavy handed approaches, like taxing unhealthy food.

Our aim is to explain all this as simply as possible. However, we are battling with a complex, evolving science with a list of jargon that sound like villains from Star Trek: antioxidants, phytochemicals, carotenoids, flavonoids, isoflavones, methyl groups, pre – and pro-biotics. Fancy your chances of sifting the good news from the bad that comes out of this exercise? Of course, that’s the whole mission of the snake oil salespeople from the food manufacturers and the food fashion industry: to capitalise on the fear, intimidate with complexity, and profit from the gullible. No wonder people in front of you in the queue at the diner take so long to decide what to order.

It shouldn’t be this hard. We shouldn’t have to do something really special to be healthy; humankind has got this far without worrying about its food. Do we really, all of a sudden, need a PhD in biochemistry to stay alive and enjoy good health? Hardly. We have made it far more complex than it needs to be. To help you (and remind us!) we’ve attached a Glossary at the end of the book to aid you as you navigate the nutritional maze. We have also dotted through the book some ‘Bite Sized Tips’ and ‘Wise Morsels’. Bite Sized Tips are key messages from the book that can be applied to your everyday life, whilst Wise Morsels are more in the way of musings on our society and how we relate to our food.

Time to begin our sleuthing. We will start with the obvious first question: Does food make any difference to our health?

CHAPTER ONE:

Food and Fatality – A Factual Perspective

If I had known I would live this long, I would have taken better care of myself

– Anon

Does food matter?

Well, yes, obviously. In order to stay alive and healthy, we need nutrients — the things we take in from our environment in order to live and grow, including oxygen, water and all the goodies we get from food. We don’t have to look far to see what happens when we don’t have sufficient food. Around a billion of the world’s seven billion people are malnourished, and the tragic health consequences of malnutrition are obvious.

But in today’s mostly cosy, well-fed New Zealand, how much should you be worried about what you eat? Should you listen to the barrage of advice and adopt heroic strategies to shun the potentially lethal combinations of pesticides, sinister additives, refined carbohydrates, saturated fats, accumulated heavy metals and dairy and animal proteins that await the unwary on supermarket shelves? Or can you ignore the beat-up from the Nutrition Nazis and commend your soul to the food companies, trusting the calm assurances of their advertising that if you choose their product, you’ll be ingesting only the latest and greatest of wonder foods? These are, after all, the two extremes. Let’s summarise this debate.

Kiwis are living longer, lasting on average over 80 years, and up until now life expectancy has continued to rise. If our diet is so bad, why hasn’t this trend stuttered and faltered? Life expectancy has even risen amongst the poorest groups in society, who are the least likely to be able to afford ‘good’ food (whatever that is).⁶ Sure, it isn’t rising at the same rate as for richer groups, but it is rising nonetheless. At first glance, and despite the alarmism around food and nutrition, there are few signs of impending apocalypse at the hand of the modern Western diet.

As we discussed in Health Cheque, longer life expectancy has come about as we have become better off and can afford better housing, sanitation, water, healthcare, education and to inoculate against epidemics. And the mass production of food has created a safer, more stable food supply, so we have less incidence of food-borne and disease less starvation. The judicious supplementation of certain foods has also eradicated some common health problems from the population. For example New Zealand soil is low in iodine, but by adding iodine to table salt and (more recently) to bread, we virtually eliminated the deficiency disease, goitre.

But just because life expectancy has risen to date doesn’t mean it will continue to rise or even hold in the future. As we noted in the preface, the life spans of the up and coming generation could fall short of their parents’. In the West, there has been a significant rise in the rates of diseases of affluence (aptly known as ‘affluenza’), such as heart disease, diabetes, strokes and cancer. These are now our society’s biggest killers, together accounting for more than half of all deaths.

Of course, you have to die of something and extending life expectancy means more of us die of the diseases of the old. Cancer is such an affliction. The risk of dying of cancer increases tenfold with each passing decade. Age, not diet or even pollution, is the strongest and most powerful predictor of cancer.⁷ By continually trying to extend our lifespan, we are hitting our heads against the brick wall of genetics. Maybe our bodies simply have a ‘USE BY’ date on them that we can’t extend. There is no way for Nature to eliminate the genetic defects that accompany old age. Old folk don’t — as a rule – breed, so how can we naturally select for the genes of the few of us who go on and on passing down their secrets to longevity? Bottom line: if you want to lower your chances of dying of cancer, don’t get older!

Despite living longer and longer, we are actually worrying about our health more and more. Has life just become so easy and spare time too bountiful that — compulsive worrywarts that we are — we’re reduced to fretting about all that’s left to fret about, the inevitability of our mortality? Can’t we just accept that on average we will have 80 odd years on this planet and go out and enjoy it while we can?

Unfortunately, this fatalistic view – that our modern diseases are simply the consequences of longevity – doesn’t stand up to scrutiny. Even when we account for age, these diseases of affluence don’t appear to have existed in hunter-gatherer societies. Sure, they had an appalling life expectancy by today’s standards, but that was mostly because the average reflected the large number of people who died as babies.⁸ Hunter-gatherer societies still had pensioner-aged people, and even then they were more likely to die of accidents than of heart attacks, strokes, cancer or diabetes. In fact, the rise in our life expectancy has largely come from eliminating premature deaths (such as infant mortality). The maximum life expectancy hasn’t moved that much: there are just more of us getting there, which lifts the average.

So the question isn’t how long do we live, but how long should we live? And here, the bulk of evidence suggests that what you eat has a large impact on your health⁹, and is a major risk factor for illness alongside smoking, alcohol intake, exercise and genetics. The relevant question here is: how much difference can nutrition make to the length and quality of our lives?

The answer is quite a lot, actually. One study followed a random sample of over 20,000 people in the UK for fourteen years. In any one year, people who were active, non-smoking, drank in moderation, and ate more than 5-a-day servings of fruit and vegetables had a risk of premature death (deaths that don’t need to happen as early) that was one quarter the risk of someone with all of the unhealthy habits (not exercise, smoking, drinks excessively, doesn’t eat fruit and veg).¹⁰ So while an unhealthy lifestyle doesn’t guarantee a death sentence, it does increase the risk of premature death fourfold, and on average knocks around 14 years off your life expectancy. These are big differences.

Thanks to all the effort that has gone into reducing smoking, diet has now become the top risk factor contributing to premature death in New Zealand. There are between 8,000-9,000 premature deaths each year that can